IJSR International Journal of Scientific Research 2277 - 8179 Indian Society for Health and Advanced Research ijsr-7-6-15812 Original Research Paper Prevalence Of Normal Epicardial Coronaries In Treadmill Test Positive Patients B Dr. Swaminathan Nagarajan Dr. June 2018 7 6 01 02 ABSTRACT

 Need of the study:Coronary artery disease are increasing across the world due to increase in obesity, dyslipidemia, diabetes mellitus, hypertension

( Syndrome X). Myocardial ischemia is in these group of patients are underestimated. Treadmill test in these patient is valid tool to diagnose the
coronary artery disease. Patients with angina with positive stress electrocardiogram may have normal coronary angiogram. Reason for normal
coronary angiogram in the background of angina may be due to vasospasm, microvascular dysfunction. Normal coronary angiogram following
abnormal exercise stress test puts patientsat higher risk of developing future coronary heart disease. Even with no occlusion in coronary arteries,
patients are at risk of recurring coronary events such as myocardial infarction and death.
Aim:The objective of this study is to analyze the prevalence of normal epicardial coronary artery by conventional coronary angiogram (CAG) in
patients with positive treadmill test.
Materials & methods: It is a prospective observational study done in our Institute of Cardiology, RGGGH & Madras Medical College, Chennai
from March 2017 – Sep 2017 on 110 exercise stress electrocardiogram positive patients with initial presentation of atypical angina. These patients
were subjected to invasive coronary angiogram after excluding the contraindications at our Institute.
Results:Out of 110 TMT positive patients, 34 % patient had normal epicardial coronaries on CAG. Out of this proportion, 61 % were female and
39% patients were male. In female population, subgroup analysis showed 26% were in pre menopausal stage. Average age of our study population
was 52 years. Risk factor analysis, hypertension (52%) was predominant then diabetes (39%), dyslipidemia (36%). On hemodynamic response
analysis 58% study population showed exaggregated systolic BP response during the stress test. Target heart rate was achieved in all patients. On
functional capacity analysis, majority of patients achieved good exercising capacity with MET of average 9 METS. No angina or arrhythmia or
hemodynamic compromise during the study.
Conclusion:Treadmill test is effective tool in diagnosing ischemic heart disease in high risk population. In our study of about 34% patients who
showed positive stress electrocardiogram with atypical angina had normal epicardial coronaries. Normal coronary artery patients are
predominantly female with hypertensive response during the test. Reason for angina in these patients may be due to vasospasm or microvascular
dysfunction. These patients may be appropriate candidates for formal studies of vascular function and aggressive risk factor modication.