What risks should I know about before getting an angiography?

Question

Hello doctor,

My mother is 50 years old and is suffering from heart disease. Her ECG shows sinus tachycardia with a heart rate of 99, biatrial enlargement, QRS area measurements of 15 in V1 and 0.30 in V2, and abnormal left-axis deviation (LAD). There is early R-wave progression and a QRS area of 0 in V2, indicating left ventricular hypertrophy (LVH) with secondary repolarization abnormalities. The criteria for LVH are abnormal, with ST-T changes suggesting anterior ST elevation, probably due to LVH, with ST-segment elevations of 0.20 mV in V1 and V4. There is also baseline wander in leads V1, V2, V3, and V4. The heart rate is 110 bpm, PR interval is 166 ms, QRS duration is 69 ms, QT interval is 319 ms, and QTc is 432 ms. The axis measurements are: P wave 75°, QRS 30°, and T wave 186°. The leads are placed according to standard protocols.

The cardiologist recommends an angiogram, but my mother is uncomfortable with the procedure. Additionally, she has thyroid problems and is currently taking blood pressure medication (Met XL) and Aspirin EC. Please advise whether she needs to undergo an angiogram.

Answer 1

Hello,

Welcome to icliniq.com.

Firstly, please take a picture of the ECG (electrocardiogram) and upload it. The report you provided is machine-generated and often inaccurate, making it unsuitable for a proper opinion. However, based on the mentioned report (attachment removed to protect patient identity), it appears that there are changes in the ECG. These changes may be due to hypertension alone. Therefore, she should have an echocardiogram (echo) performed, which will help clarify the need for angiography.

If the echo is abnormal and suggests blockages, then she will need to undergo angiography. If the echo is normal, she should have a stress thallium test, which is a non-invasive procedure to assess for blockages and rule out any potential issues.

In summary, please upload the ECG and ensure that an echo is done if it has not been completed yet.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

It looks like the ECG has not been uploaded yet. However, I have reviewed the ECG interpretation provided by your doctor in the case summary. In my opinion, getting an angiogram done is not a bad option, though it may not be absolutely necessary. There is a strong possibility that the changes in the ECG are due to hypertension or hypertrophic cardiomyopathy. That said, we should also rule out any potential blockages.

To do this, a stress test, such as a stress thallium test or CT (computed tomography) coronary angiography, would be helpful in assessing for blockages. Please continue taking the prescribed medications until we confirm the diagnosis.

Additionally, the diagnosis mentioned in the echo (attachment removed to protect patient identity) indicates hypertrophic cardiomyopathy, which represents a different spectrum of disease and is usually not a cause for concern. It would be beneficial to visit a specialized center for confirmation and management of this diagnosis. I recommend visiting a nearby tertiary center for further evaluation.

Thanks and regards.