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

### input:
My wife age about 45 yrs is suffering chest pain and discomfort on excertion last 3 months i have consulted with one cardiologist and advice  me  for TMT test, accordingly after test 74%of cardiac excercise test is positive for provocable myocardialischaemia. what is the next treatment and where I can get proper advice please confirm immediately.

### output:

HelloThanks for posting at Chat Doctor. Your wife has symptoms of chest pain and discomfort on exertion which are very typical for angina sectors or ischemic heart disease. This means there are some blocks in the heart arteries. When a patient with such blocks walks or exercises, the heart rate increases and its blood and oxygen demand increases. Since the arteries are blocked, they cannot cope up with the extra demand of blood and oxygen while exercising or walking. This causes the chest pain/discomfort. This same principle is used in a TMT. You are made to exercise on a treadmill while your ECG is continuously being recorded to see whether the ECG shows changes while walking corresponding to her chest pain. Hence, it is called provocable ischemia since we provoke the event. Before a TMT, a target heart rate is set for the patient till which the patient is usually made to walk on the treadmill. This target heart rate is usually 220 - age of the patient. Your wives TMT showed changes of ischemia or deficiency in blood supply at 74% of this target heart rate. Hence, this is a positive test and indicates a strong possibility of blockages in the heart in view of typical symptoms and a positive TMT. Your cardiologist will advise a coronary angiography for her which is an invasive test done through a small hole in the hand or the leg. This will show the blockages in the heart and their severity. On basis of the angiography findings, further treatment (medical management vs angioplasty vs bypass) can be discussed. My feeling is she would require an angioplasty. Please go ahead with an angiography and revert with the findings. Wishing her good healthRegards