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Need second opinion on going for angio
Experiencing angina-like symptoms for 1 month: chest pressure, heavy jaw, and left shoulder/arm pain at rest and on exertion.
Investigations:
• CT coronary angiogram last year: normal, no major blockages
• Stress echo in June: normal
• Last TMT a month ago: normal
• Cardiologist consultation 2 weeks ago: ECG, ECHO troponin normal
Currently taking Bisoprolol 2.5 mg and DULOEXTINE
Cardiologist says can do angiogram, but I prefer to avoid it. He said a repeat CCTA isn’t needed so soon.
Question: Are there any other options to rule out heart issues?
Answers (48)
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Can help you with the next course of action and treatment plan. Kindly consult via whatsapp at nine zero two nine six zero zero four seven zero.
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+113
Whats BMI
Is there family history
Is there dyspnea on exertion, or chest pain on exertion,
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At 26 years old, with normal CT coronary angiogram (last year), recent TMT, stress echo, ECG, ECHO, and troponin, the likelihood of major coronary blockages is very low.
• Angiogram: Usually reserved if non-invasive tests are abnormal or symptoms are severe/progressive. Not essential right now.
• Other options: Stress cardiac MRI (to check microvascular angina), Holter monitoring (for rhythm issues), or coronary calcium score for long-term risk.
• Non-cardiac causes: Acid reflux, muscle/nerve pain, or anxiety should also be considered. Duloxetine can help in some of these.
• Current meds: Bisoprolol is appropriate. Continue as advised.
Summary: Your tests are reassuring. Explore non-cardiac causes, consider cardiac MRI/Holter if symptoms persist, and follow up with your cardiologist. Seek urgent care if pain becomes severe or associated with sweating, breathlessness, or fainting.
Health Tips
Focus on lifestyle: diet, weight management, and regular exercise are very important to keep your heart healthy. I can guide you with a structured diet plan if you’d like, and you can consult me for detailed advice.
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What are your lab reports? Diet control and exercise advised
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You can go for coronary angiography as it is best to rule out heart disease..
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Avoid stress and heavy exercises till the confirmation
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Hello since the above investigations are normal its best to once consult and get a opinion from chest physician and a through clinical examination is required to rule out musculo skeletal pain also.
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Avoid heavy workouts and stress till the final diagnosis
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Well above mention test are not conclusive
Next Steps
Coronary angiogram is better option
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Once it’s done then it’s confirmative atleast you don’t need to worry from heart side
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Your should consult chest physian for detail evaluation of respiratory system.
Next Steps
consult
Health Tips
nil
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Need details
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Do not worry as reports are normal
Take tab Medha vati 3 times
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Need more details like lipid profile reports and family history
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Detail history and clinical examination is necessary first.
With few specific diagnostic tests .
Life style modification
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don't worry will take care .
visit or consult
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U should have a angiography done for the symptoms
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Since your CT coronary angiogram, stress echo, TMT, ECG, ECHO and troponin are all normal, the chance of significant coronary artery disease is very low.
A repeat CTCA isn’t needed so soon.
If you still have symptoms, other possibilities like
anxiety,
GERD (acid reflux),
musculoskeletal pain (costochondritis),
or cervical spine issues should also be considered.
Next Steps
Continue your prescribed medicines.
Monitor lifestyle factors: weight reduction, exercise, diet control, avoid smoking/alcohol, manage stress. If symptoms persist or worsen, a cardiac MRI or Holter monitoring may help to rule out rhythm issues or microvascular angina.
Health Tips
Invasive angiogram is only considered if symptoms are severe or progressive despite normal tests.
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Hey as your all report are normal u need some more report specific for heart .Angiography is not an early indication for your symptoms..
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Hello , Kindly consider having a Tele-Consultation with me on PRACTO App since adequate patient history is required for proper treatment and further follow up . Thank You
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There's no indication for the angiography for you,as all non invasive investigations including the coronary CT angio which is very sensitive,are negative for coronary artery disease
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Autopsy.
But it may be a little too late.
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No , angiography is must if u have symptoms
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Hi. Your all reports normal as your cardiologist.
You need also do few others tests and confirm with cardiologist or physician.
BP, PR, lipid profile, urine R/m, bs fasting-PP, cpkmb, vitamin D3, vitamin B12.
After reports take consultation.
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Kindly consult
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Final and having more accuracy to find any abnormalities in coronary vessels is coronary angiography.
You need to concentrate on your lifestyle modification and check your sleep pattern.do meditation and other moderate physical activity.
Next Steps
Cardiology consultation
Health Tips
Meditation,Psychiatric consultation,psychologist consultation
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Connect
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All cardiac tests normal, no possibility of a heart disease currently.
To clear your anxiety, you can repeat tests after one year or 2.
Follow a healthy life style.
Get thyroid function tests done.
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When non invasive work up is normal angiography is not needed
Anxiety seems to be playing role in your symptoms
Regular excercise is key to physical and mental fitness,
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For a 26 year old ,
normal tests, and a normal CT angiogram just last year, serious coronary artery disease is very unlikely.
Please evaluate for non-cardiac causes before invasive angiography
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Hey, I dnt think you need angiography at all. All your tests are good. Still if u have queries, kindly consult with me on 94 two six eight six 78 nine six
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Angiography
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your cardiac profile has already been taken care of. I would advice to consult a orthopedic surgeon to rule out cervical issues
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Need few more details for proper understanding of your issue.
You can consult with me online on Practo or whatsapp on eight three one eight four six nine eight eight six for proper diagnosis, conclusion and management
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Hlo sir If you want to discuss your problem in more detail, feel free to message me on Whats App at nine one one nine two five five six nine nine for al free detailed discussion
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Connect
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You can consult me directly on Practo, or reach out via WhatsApp:
Eight Seven Six Two Seven Four Nine Nine Seven Four
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Early consultation helps avoid complications — feel free to connect.
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Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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Hello,
For Medical Diagnosis and Treatment please pay and consult at practo or pay and consult at WhatsApp.
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Jai hind. 🇮🇳
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Need few more details
Kindly consult
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No need.
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No need to do Angiogram now . You can wait .
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You should not ignore your symptoms these days..Go for an ECG test as soon as possible so that any possibilities of heart disease can be ruled out
Next Steps
Continue taking your medications
Health Tips
Listen to your cardiologist as he will never give you a wrong opinion but at least do ECG
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Dr. Shaikh Huzaif
General Physician
20 yrs exp
Mumbai
Please consult
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Dr. Anand Prakash Pandey
General Physician
8 yrs exp
Delhi
Get a Holter monitoring done for 3 days and also can go for cardiac mri
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Dr. Marini Vanitha
General Physician
12 yrs exp
Kakinada
It's Anxiety.
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Dr. Bhagirathsinh Zala
General Physician
3 yrs exp
Jamnagar
The short answer is yes, there are other options and considerations, but it's crucial to understand the context of your specific situation. Your cardiologist's suggestion of an angiogram is a very reasonable one given your symptoms, but your preference to avoid it is also valid.
The Central Paradox: Symptoms vs. Test Results
You are experiencing classic angina symptoms (chest pressure, jaw/shoulder pain), which are very concerning. However, your standard tests are normal. This creates a diagnostic challenge. The goal now is to find a test that can explain why this paradox exists.
The tests you've had are excellent at ruling out large, obstructive coronary artery disease (blockages in the major arteries). Since they are normal, the likelihood of a significant blockage is low. However, your symptoms suggest there might be an issue with blood flow to the heart muscle that these tests aren't designed to detect.
---
Potential Alternative Avenues to Discuss with Your Cardiologist
Here are some options that could help get more information, focusing on conditions that standard tests might miss.
1. Advanced / Functional Testing for Coronary Blood Flow
This is the most critical area to explore. Your symptoms could be due to problems with the microvasculature (tiny blood vessels) or the function of the arteries rather than a physical blockage.
· Coronary Flow Reserve (CFR) Measurement: This test assesses how well the small vessels in your heart (microvasculature) can dilate to increase blood flow when needed. It can be done during an echocardiogram using an intravenous contrast agent (Contrast Stress Echo) or during a nuclear stress test. A reduced CFR indicates Coronary Microvascular Dysfunction (MVD), which can cause angina even with clean arteries on a CT scan.
· Invasive Functional Assessment (if you proceed with angiogram): If you eventually opt for an angiogram, you can ask them to perform a Fractional Flow Reserve (FFR) or Index of Microvascular Resistance (IMR) measurement. FFR checks the pressure across a specific artery to see if a narrowing is significant, and IMR directly assesses the health of the microvessels. This turns a purely anatomical angiogram into a functional one.
2. Investigating Vasospastic Angina (Prinzmetal's Angina)
This condition involves sudden, temporary squeezing (spasms) of the coronary arteries, which can severely reduce blood flow and cause rest pain. It would not show up on your previous tests.
· Provocative Testing for Coronary Artery Spasm: This is a specialized test performed during a coronary angiogram. A medication is injected into the coronary arteries to provoke a spasm. If a spasm occurs and reproduces your symptoms, the diagnosis is confirmed. This is the only definitive way to diagnose this condition. Given that your pain occurs at rest, this is a important possibility to consider.
3. Ambulatory Monitoring
Since your symptoms are intermittent, a longer-term monitor might catch an abnormality.
· Event Monitor or 14-day Holter Monitor: You've had a resting ECG, but a longer-term monitor can check for silent arrhythmias (heart rhythm problems) or episodes of ischemia (lack of blood flow) that coincide with your symptoms.
4. Cross-Specialty Evaluation to Rule Out Non-Cardiac Causes
Your cardiologist is rightly focused on the heart. However, it is essential to systematically rule out other causes that can mimic cardiac pain. A normal troponin and stress test make a heart attack less likely, but other issues can feel identical.
· Gastrointestinal (GI) Evaluation: Severe acid reflux (GERD) or esophageal spasms can cause crushing chest pressure and pain radiating to the jaw and arm. A trial of a high-dose proton-pump inhibitor (PPI) or an endoscopy could be considered.
· Musculoskeletal Evaluation: Costochondritis (inflammation of the chest wall cartilage), muscle strains, or cervical spine issues (pinched nerves in the neck) can refer pain to the chest, shoulder, and jaw.
· Psychological Factors: Anxiety and panic attacks are famous for causing chest tightness, pain, and a sense of doom. It's important to note that this is not saying "the pain is in your head," but rather that the nervous system can produce very real, physical symptoms. The fact that you are on Duloxetine (Cymbalta), which is often used for anxiety/depression and chronic pain, suggests this may already be a consideration.
Next Steps
the key is to shift the investigation from "Are there major blockages?" (which has been largely answered) to "Why am I having these symptoms despite clean arteries?" The possibilities of Microvascular Dysfunction and Vasospastic Angina are the most important cardiac issues to discuss with your doctor moving forward.
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Needs to be evaluated
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Dr. Vinod Kumar Verma
General Physician
9 yrs exp
Gurgaon
-According to your query and sign and symptom you want to know about the cause and Treatment of disease as you have mentioned as above as -
-Please take consultation for better evaluation and best Treatment as it need complete history of patient as personal and family history.
Please follow good life style as
• take plenty of fluid and
• take less spicy and fatty foods and
• take home made food only and
do exercise regularly with yoga and meditation and
• keep positive attitude to fight any disease and any problem of your life . ....
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Dr. Nazia Begum M.G
General Physician
15 yrs exp
Belgaum
Regular blood test,lipid profile
Monitor and maintain blood pressure sugar level regularly
Avoid stress
Diet control
Regular walk exercise daily
Regular check up
Healthy lifestyle
Consult online will guide you
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Dr. Gaurav Jaiswal
General Physician
6 yrs exp
Jhansi
Avoid fried and spicy food
Water intake more
Green leafy vegetables more
Fiber meal
Walk
Do connect and consult
Inform
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Dr. Shivani B
General Practitioner
Bangalore
Since all the tests are normal just continue ur tablets, no need to worry
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