Is a stress echo test required before an angiography?

Question

Hello doctor,

My wife is 47 years old. A few days ago, she suddenly experienced palpitations while sleeping. We went to the hospital, where her ECG and echo tests came back normal, and her troponin I test was also normal. However, her treadmill test (TMT) was positive. One doctor advised us to proceed with angiography, while another suggested we should have a stress echo test before undergoing angiography. Please advise on what should be done first.

Answer 1

Hello,

Welcome to icliniq.com.

Firstly, let me know if she has any risk factors, such as hypertension, diabetes, a deranged lipid profile, or a family history of heart disease. Usually, since angiography is an invasive test, we ensure that it is necessary. We typically subject patients to less invasive tests like a TMT (treadmill test), stress echo, or stress thallium first. If either of those tests is abnormal, it is advisable to proceed with angiography.

In her case, since her TMT is positive, it would be better to subject her to angiography. While there is no harm in performing a stress echo, if it turns out positive, she will definitely need angiography. However, if the stress echo is negative, we may find ourselves in a dilemma about which test to trust. In that situation, she may require additional tests, such as stress or CT coronary angiography, to confirm that the TMT result was accurate.

Thus, it is better to proceed with angiography to clarify our doubts, especially since there is sufficient evidence of abnormalities, and angiography is considered the gold standard test. Also, please discuss how strongly positive the TMT result was. If it is strongly positive, we should proceed with angiography without hesitation. If it is only mildly positive, then we might consider a stress echo. Overall, undergoing angiography is advisable, and there is no harm in a stress echo if your doctor recommends it.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

If she feels heaviness in her chest, then she should definitely get an angiography done. Since she was only able to exercise for 4.5 minutes, it is necessary. Angiography is generally a safe procedure, although there is a small risk of bleeding. The risk of major complications is very low, at about 0.1 percent.

Thanks and regards.