Q: My husband is 38 years old. He weighs 75 kg and is 172 cm tall. He has uncertain flickering momentary pain (for few seconds only) around the chest from the past 2-3 years. Last year his resting ECG and blood tests were normal. So our general physician told us to forget this. But the flickering pain continued. We consulted a cardiologist last month, who also took his resting ECG, which was normal again. To confirm nothing is wrong he advised exercise ECG. This is positive with ST segment depression on nearly all leads. His blood report is nearly normal but the typical Indian quality of slightly high triglycerides and low HDL. The cardiologist advised to go for an angiogram. He says the exercise ECG could be 50% positive or 50% negative. But only angiogram will confirm if he has any anatomical/physiological changes in the cardiac vessels. We are quite concerned about angiography as it is an invasive test. Can MRA or electro-beam CT scan or the nuclear test be equally diagnostic? If these are negative, is that confirmatory that his exercise ECG was a false positive report? Or should he still go for angiography? How can the HDL levels be increased? What medicines should he take? If he has to go for angiography, what pre or post-test measures have to be taken, like less travelling after the test (he has to travel frequently in his job) to avoid any thrombotic event?

A:Incase your husband has no other risk factors for blockage in the coronary artery, such as smoking, a family history of heart attacks or heart disease, diabetes, etc; it seems reasonable to undergo a dobutamine stress echo or a stress nuclear perfusion scan. If this is negative, one can reasonably be sure that the TMT was falsely positive. If however, he has any of the risk factors, then it is better to go for an angiogram, as this continues to be the gold standard test. Currently an angiogram carries very little risk, and the patient is often discharged on the same day and can resume normal activities in 24 hours.