TMT positive but normal angiogram: What could be the reason?

Hello Jeyasingh Ji,

Thank you for your question. A positive TMT (Treadmill Test) indicates that there may have been reduced blood flow to the heart during the stress test. However, a normal angiogram suggests no significant blockages in the coronary arteries. It is important to note that coronary angiogram is considered the gold standard for detecting blockages in the coronary arteries. This discrepancy can occur due to several reasons:

Possible Reasons:

1. Microvascular Angina: Small blood vessels in the heart may be affected and may not show up on a standard angiogram.
2. False Positive TMT: Factors like anxiety, technical errors, or certain medications can lead to a positive TMT result even without significant blockages.
3. Coronary Spasm: Temporary narrowing of coronary arteries due to spasms can cause TMT changes.
4. Other Conditions: Issues like anaemia or electrolyte imbalance may mimic ischemic changes.

Next Steps:

1. Further Tests: A repeat TMT or a stress echocardiogram can help evaluate your heart function under stress conditions.
2. Lifestyle Management: Focus on a heart-healthy diet, regular exercise, and stress management.
3. Follow-Up: Regular check-ups with a cardiologist to monitor your heart health.

Request for Additional Information:

To provide better guidance, could you share:

• Any symptoms during the TMT (e.g., chest pain, breathlessness)?
• Medical history (e.g., diabetes, hypertension)?
• Any medications or family history of heart disease?