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Q. I have attached my mother-in-law's ECG and echo. Is angiography necessary?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 31, 2020

Hi doctor,

Twelve years back, my mother-in-law's pulse had drastically fallen, and she was admitted to a hospital. Subsequently, a pacemaker was inserted. It was replaced four years back.

Today we had gone for a routine checkup, as she was complaining of upper back pain and blackouts yesterday. The hospital had done the ECG and echo today, and they told us that she needs an angiography. Please advise us whether it is the right course of action. We are very anxious about the procedure.

I am attaching the prescription, ECG, and echo for your reference. Thank you.



Welcome to the

  • Could you please describe her symptoms in detail, including back pain and blackouts?
  • Did she experience interruption while getting up from sleep or while sitting?
  • Is she experiencing back pain recently or for a long time?
  • Any worsening of pain from movements?

Now her echo is subtle, and ECG (electrocardiogram) shows paced rhythm, which is fine with pacemaker pacing her heart. So I do not see any indication based on reports <attachment removed to protect patient identity>.

However, if she had typical symptoms of heart attack or disease like chest pain (or even back pain sometimes) on exertion associated with sweating and uneasiness, then she may consider angiography.

Even otherwise, angiography nowadays is not a major test, and she may undergo it to clarify things. Alternatively, she may undergo CT (computed tomography) and coronary angiography.

Thank you.

Thank you, doctor.

We have checked with our mother-in-law. Regarding the back pain, she says that it has started only recently around 15 days back, and she gets it back only when she stands for a long time; otherwise, she does not have back pain. The blackout happened once when she was standing in the kitchen for almost half an hour, and it lasted for ten minutes. She also gets dizziness immediately after lying down but not every day. And she also has diabetes. We have also noticed that her diet is minimal, and maybe because of that, she is getting dizziness.

Please advise.



Welcome back to

Her symptoms are not very suggestive of a heart attack. Back pain is probably related to musculoskeletal causes like spinal issues. Dizziness is probably related to postural hypotension rather than cardiac. Cardiac pain would typically occur on exertion and relieves with rest (not related to standing). However, some amount of blockages are expected at this age and being diabetic. So your mother-in-law may undergo angiography or CT coronary angiography to look for the status of blockages.

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