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Heart & Cardiology/Strong Positive Stress ECG

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Question
Stress
Stress  
Dear Respected Sir
I am a Year 2 MBBS student and my dad is aged 59years.He is hypertensive and was doing well with 5Mg Amlodipine.(Norvasc).He is 96kgs/Height 174Cms.
From the last 10 days he has been having chest pain which was more if he walked fast,it improved slightly with omeprazole.He has been on Etoricoxib 60mg from about 4 months due to arthritis.Before this he was taking Diclofenac Sodium from a eriod of 2 years.He is also taking Gabapentin 400 mg due to slip disc in c6.

My dad did not want to visit a cardiologist as he claimis he dad similiar pain 30years ago.

I forced him to see my professor in the hospital,A MRCP Cardiologist.The ECG was normal,he advised to come visit for a stress ECG.On doing the stress test,He started feeling pain at 4.5mins due to which test was stopped.
The doctor advised to do an angiography and labelled the result as strong postive.

He prescribed the following medicines:
Clopidrogel 75mg,Bisoprolol fumerate 2.5mg,Aspirin 100mg,Atrovastatin 40mg.Amplodipine to be continiued.

My dad has been in a state of denial and angry with me,he refiused to do the angiography and refused to take the medications,he calims that he is well and that I am trying to label him as diseased.He is being angry and sad.

I have convinced him to take the other medication expect the beta blocker bisoprolol,he is takiing the Amplodipine 5mg.

My question is whether the stress ECG can be false positive?Is there any other way to diagnose CAD non invasively.
Is it Ok if he skips the Betablocker,His BP is controlled.It increased only while doing the strees till around 198 systolic.

His right eye has been red from yesterday.Is this dangerous.(we did the stress ecg day before).

I would like your expert advisein dealing wit this as I am extremely worried.

Kindly reply at the earliest

Thank You for your time..

Answer
Hello Mamoon,

The indication for intervention with balloon or bypass is pain he doesn't want to put up with.  Tho his pain almost certainly comes from narrowing of coronary arteries, he is no more likely to have heart attack or cardiac death than if he underwent intervention, if he takes the medicines regularly.  Beta blockers help prevent heart attack and he should take the beta blocker.  Non invasive location of narrow places is possible with CT angiography or MRI, but he would need regular angiography before any intervention.

Please write back if this note doesn’t answer all your questions.

David Richardson

Heart & Cardiology

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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