Do I need to undergo an angiogram?

Q: I am a 58 years old male who recently got an annual heart check-up done. The cardiologist told me that my ECG is not ok and in fact, he did not allow me to complete the treadmill test. The downward pointing valleys on the ECG were longer than they should be. The doctor suggested that I should have an angiogram done, but because it is an invasive procedure, I asked for an alternative. He suggested radioisotope scan. How do I decide which is the best procedure for me now? I have a family history of heart disease and my previous angiogram showed a 30% lesion.

A:From your reports, it appears that you ideally should undergo an angiogram in view of your family history and the finding of a 30% lesion in your previous angiogram. But as your cardiologist suggested, it would be better to exhaust non- invasive modalities first. Hence, an isotope scan would be advisable as it would indicate whether or not, you will require a formal invasive angiography. This investigation will reveal any area of heart muscle that is ischemic and hence dictate the need for a further invasive angiogram. However, the final call in this regard would be better taken after discussion with your treating cardiologist.