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.

Whats BMI Is there family history Is there dyspnea on exertion, or chest pain on exertion,

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.

What are your lab reports? Diet control and exercise advised

You can go for coronary angiography as it is best to rule out heart disease..

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.

Well above mention test are not conclusive

Your should consult chest physian for detail evaluation of respiratory system.

Need details

Do not worry as reports are normal Take tab Medha vati 3 times

Need more details like lipid profile reports and family history

Detail history and clinical examination is necessary first. With few specific diagnostic tests . Life style modification

U should have a angiography done for the symptoms

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.

Hey as your all report are normal u need some more report specific for heart .Angiography is not an early indication for your symptoms..

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

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

Autopsy. But it may be a little too late.

No , angiography is must if u have symptoms

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.

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.

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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.

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

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

your cardiac profile has already been taken care of. I would advice to consult a orthopedic surgeon to rule out cervical issues

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

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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You can consult me directly on Practo, or reach out via WhatsApp: Eight Seven Six Two Seven Four Nine Nine Seven Four I’ll guide you step-by-step with easy-to-follow treatment plans. Early consultation helps avoid complications — feel free to connect. Only whatsapp message no calls

Hello, For Medical Diagnosis and Treatment please pay and consult at practo or pay and consult at WhatsApp. My WhatsApp number is same as my mobile number . My WhatsApp number is +91959508739nine. Take a glass of milk daily. Thanks. Dr☆MPB  , Dr Praful Mahamuni, Family Doctor, MBBS . Jai hind. 🇮🇳

No need.

No need to do Angiogram now . You can wait .

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

Please consult

Get a Holter monitoring done for 3 days and also can go for cardiac mri

It's Anxiety.

Kindly consult

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.

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,

Angiography

Needs to be evaluated

-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 . ....

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

Avoid fried and spicy food Water intake more Green leafy vegetables more Fiber meal Walk Do connect and consult Inform

Can help you, kindly consult and provide detailed history for proper diagnosis and further management

Since all the tests are normal just continue ur tablets, no need to worry

Need few more details Kindly consult