Q: I am a 53 years old man who underwent a comprehensive health check up recently. I have been hypertensive for the last 7-8 years and have been detected with type 2 diabetes three years ago. My fasting blood sugar level is 142 mg/dl and postprandial (PP) is 271 mg/dl, HDL cholesterol - 23 mg/dl, LDL cholesterol - 128 mg/dl, HDLC - 9.5, triglycerides - 339 mg/dl, VLDL cholesterol - 68 mg/dl and total cholesterol - 219 mg/dl. My ECG was normal. I also underwent a treadmill test for ischaemic heart disease (IHD) evaluation. Protocol used was BRUCE and findings are as follows - exercise time: 6.36 min, end point - MHR received – maximum, heart rate - 171, maximum blood pressure - 200/80 mmHg, maximum pulse pressure product - 34, 200, estimated work load - 7.90 mets, symptoms - nil, signs - nil. The doctor concluded that the stress test is positive for inducible ischaemia at fair workload. Normal HR and BP responses. Fair effort tolerance. Do these tests suggest any blockage in arteries? Do I need to undergo coronary angiography?

A:Certainly if the stress test is positive, then you must go for coronary angiography. Stress test is sensitive and specific to the tune of 85% of cases. In 8% of cases, you can get false positive result, that is stress test positive suggesting that the coronary arteries are blocked, but when we do coronary angiography, the arteries may be normal. But in overwhelming number of cases, stress test correlates with blockages. In your case, you have so many risk factors like hypertension, diabetes, all round sub-optimum lipid profile that stress test positivity calls for a coronary angiography most certainly.