TMT is positive. Should we take angiography or stress echo test?

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Firstly, let me know if she has any risk factors like hypertension, diabetes, deranged lipid profile or family history of heart disease. Usually, what we do, since angiography is an invasive test, we make sure that the patient needs it or not. So initially, subjects the patients to minor tests like TMT (treadmill test) or stress echo or stress thallium. If either of the tests is abnormal then it is better to subject to the patient to angiography. Now, in our case, since her TMT is positive, it is better to subject her for angiography. There is no harm in having stress echo, but suppose it is positive then certainly she will need angiography. But if it is negative then we can again land up in a dilemma of which test to be relied upon. Then she will need some more tests like stress or CT coronary angiography to prove TMT was negative. So it is better to get an angiography done and clear all our doubts. There is sufficient evidence of abnormalities and angiography is a gold standard test. Also, discuss how strongly was TMT positive. If it is strongly positive then nothing to think and go ahead with angiography and if it is mild positive then you may think of stress echo. So overall, it is better to undergo angiography and no harm in stress echo if your doctor insists.

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If she feels heaviness then certainly she should get an angiography done. Also, she just worked for 4.5 minutes. So, she will need it. Angiography is usually a safe procedure, some risk of bleeding is there. Very small risk of major complications (0.1 percent) is there.