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Chest pain with LAD artery ANGIOPLASTY and negative TMT.

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Dear Dr.
I had a massive heart attack in the year 2000. Within two weeks angioplasty was performed on me in LAD coronary Artery. After four years old patienti.e 2004 I had undergone Bypass surgery for four vessels grafting. Every year during medical checkup my TMT result was showing negative. This year also my TMT is negative and report is like this: I am 54 years old patientold, height is 173 cm and weight is 64 Kg; total exercise period was 12 minutes and achieved 88% of maximum predicted heart rate with a calculated workload of 14.30 METS. There was no significant respiratory symptom related to exercise. Exercise was terminated due to fatigue and achievement of target heart rate. Resting blood pressure and response to exercise was normal. Resting ECG was normal. Exercise ECG: ST depression during exercise-4 stage. ST level was -0.90 mm in V5; Max HR: 88 %; Maximum workload: 14.30 METs. Conclusion: good exercise capacity. Negative TMT. I want to know that during my TMT cardiologist has stopped Tenolol-12.5 before 24 Hrs and continued Nikoran 5. Is it Ok ? Reason for asking this question is that many cardiologists suggesting to stop Nikoran 5 also before TMT. What is your view on this? My other reports: EF as per ECO is 55 %, blood sugar and cholesterol reports are normal. I am taking medicine now Nikoran 5 twice a day, Tenolol-12.5 once in a day at night, Rosuva statine 10 once in a day and Clavix 75 once in a day. My problem is I am getting pain and heaviness from my front, back and below the right side of chest since ten years old patient(after Bypass). Because of this I am feeling short of breath and heaviness while initial walking. I consulted Chest specialist and Gastroenterologist. Sonography, CT scan reports for chest and abdomen are normal. Colonoscopy and Endoscopy reports are normal. During barrium x ray reflux is detected. Gastroenterologist has prescribed me anti reflux tablet (Nexpro fast 40), which I am taking since five years. I am very much strict about consuming less oil, less fat and less Sugar in diet. My problem has reduced but not eliminated. One physician has advised me to go for angio graphy to rule out the right side pain and heaviness problem. My cardiologist is not suggesting Angiography because of Negative TMT report and said right side chest problem is not related to heart. What is your opinion? Could you please advise me what can I do now? What is the solution for this?
Warm Regards,
Shailesh Dalvi

Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.

Hello Mr. Shailesh Dalvi. Thank you for your query at DoctorSpring.com.
Ideally Nikoran should be stopped before a TMT. It may result in a TMT turning out to be negative when it could have been positive in the absence of it.
However, if you have a negative TMT with Nikoran and you already are taking it regularly, it means with the drug in your body you are unlikely to get angina.
So your chest pain is in all likelihood non-anginal given the negative TMT and atypical right sided description.
The only definite test to rule out coronary blockage is angiography.

Concluding- a TMT is not indicated for you. However, if you are too apprehensive of the chest pain being angina, you could ask for an angiography though scientifically it is not indicated or needed.

I hope this was helpful. Feel free to ask queries.
Regards, Dr Vivek Mahajan, DM Cardiology.

Patient replied :

Dear Dr. Thank you very much for your reply. When I walk, initially I feel right side heaviness and short of breath with chest discomfort from middel of the chest. After walking one Kmtrs it gradually goes away and I feel better. During TMT I have not experienced chest pain. In fact after completion of TMT, I was feeling better. My physician is in the opinion that this pain and heaviness could be because of nerves or surgical problem. Two months back my Gastroenterologist had prescribed me Nexito 10 for one month. During that period I was little comfortable. With 12 Minutes exercise period on TMT and achieved 88% of maximum predicted heart rate with a calculated workload of 14.30 METS, even with Nikorane-5, will it advisable to go for Angiography ? or continue with prescribed medicine with proper diet. Warm Regards, Shailesh Dalvi

Expert:  Dr. Vivek Mahajan replied 3 Days.

Firstly, i sincerely apologize for the late reply.
I feel your cardiologist is right in not advising you angiography. With such a good TMT result, there is absolutely no need for an angiography as of now.
I would only advise you to get it done if you are too anxious about the pain though medically it is totally unindicated.
Hope this was helpful,
And once again sorry for the delay.
Dr. Vivek Mahajan.

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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