### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, Im 36 with a 20yr history of smoking, and diabetes type 2 and moderately overweight. I was going up and down the stairs and got some mild chest discomfort. It went away, and have not experienced it again. I went to a scheduled routine appointment with my PCP who did an ekg and found some nonspecific changes and sent me to the hospital. The ekgs were negative and they ruled me out for an MI, then went to a cardiologist and told me eventhough the ekg is neg. he think im having unstable angina and said i need an emergent cath based on my risk factors and one episode of chest discomfort a week prior, he said he does not trust a stress test as it can kill me with unstable angina. I have not experience the pain ever since, and im afraid he may be jumping the gun with a cath....I am concerned that he also a stent happy type of guy. I tried to find possible alternatives such as 64 CTA, but he says I may die if I wait and have to have the angiogram. I know cath is the gold standard, but cta has a comparable negative predictive value. Other studies such as a conventional pulmonary angiogram is the gold standard to rule out pulmonary embolism, but nowadays a pulmonary angiogram is almost never ordered to exclude a pulmonary emboli.   Am I being unreasonable to consider alternatives or is a cath is absolutely needed STAT?

### output:

Hello, Brief Answer: Considering the risk factors and clinical condition, you may have ischemic heart disease. Explanation: My opinion is that you have a complaint which is chest pain with effort. With other risk factors such as diabetes and hypertension. A long history of smoking is a major risk. I suggest my patients the following EKG, routine laboratories such as Complete blood count, lipid profile and located hemoglobin to check for blood sugar control. Then other investigations as echocardiogram and stress tests may be needed accordingly. Conclusion: I suggest you start on anti-ischemic then CT coronary angiogram is not a bad choice at all if that comforts you. Hope I have answered your query. Let me know if I can assist you further.