Q: I had a slight pain in the chest while doing some strenuous work for which I consulted a cardiologist. Tests were done and ECG showed an abnormal reading; the cardiac scan impression was mild left ventricular diastolic dysfunction and the doctor treated me like any cardiac patient. For one year I was under medication and repeat ECGs showed no improvement. I was referred for Angiogram but I had a doubt on the doctor's assessment and discontinued medicines. Two years later I consulted another cardiologist who suggested a stress ECG and this showed a normal reading. The doctor opined the abnormal ECG under rest condition might be normal in my case. There has been no recurrence of pain till now and I am fine. I want to know whether I should go for a second opinion?

A:Chest pain can be because of multiple causes, one of which is through blocked arteries of the heart called angina. Just because angina is a serious matter and other chest pains relatively less important, therefore it is a common practice to presume all chest pains as of cardiac origin and anginal in nature unless and until proven other wise. It is also a fact that not all heart related chest pains will be associated with changes in the ECG and to the contrary, patients with blocked arteries may also have a normal stress ECG. Important here is to get a thorough clinical examination and risk factors profile should be screened. If an individual is more than 35 years of age and if he is a diabetic, hypertensive, smoker and if he has chest pain then he must have an angiogram even if his stress ECG or the resting ECG is normal. However, if clinical suspicion for blocked arteries is very low, the stress ECG is normal and if the chest pain does not recur then one may not worry about an occasional chest pain which may be originating from muscles or bones or other structures in the chest. However, this is a complex matter and I advise you to consult your cardiologist who can sort out for you whether the pain that you had was originating from the heart or is of non cardiac (heart) origin.