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

### input:
Hi,Help! My wife had a stress test recently because her family doctor just purchased stress test equipment(note: she has had no symptoms of heart problems but has diabetes). She was the 4th person to have the test on this equipment. According to the results stress images reveal a large sized perfusion abnormality of moderate to severe intensity in the lateral and anterolateral walls . Stress images also showed a medium sized perfusion abnormality of mild to moderate intensity in the interoseptal and inferiolateral walls. Grade V stage. Gated SPECT revealed abnormal left ventricular function with an ejection fraction of 36%. There was severe hypokinesis in the inferior, lateral, anterolateral, and inferolateral walls of the left ventricle. There is diminished systolic wall thickening in these regions as well. Images would appear to show that heart is not functioning while under stress.Family doctor and specialist are recommending Standard Angiogram.Wife and I have doubts about the validity of the test because she was the 4th patient to have it(at least 1 other patient had an abnormal reading). Also there is a percentage of false positives in females.When we suggested a CTA doctors balked saying that she would still need a Standard Angiogram.Are we wrong in wanting the CTA first(we would pay entire cost of test) then if indicated have the Standard Angiogram.Thank you for reading and hopefully replying.

### output:

Hello thanks for posting here.  I have gone through the findings of the stress imaging. It is a very sensitive test for diagnosing coronary artery disease. By the reports of her stress imaging it appears she has multiple areas of blood supply insufficiency. It is a quite sensitive test and there is no reason to suspect report or images may not be accurate because it is new. Also, a faulty machine would not show so many deficiencies. So she definitely has significant coronary artery disease which is indicated by multiple areas of perfusion abnormality with decrease in contractile function to 36% and amnesia/hypokinesis. Should she undergo a conventional angiogram and not a CTA? CTA has more of a role in patients in whom diagnostic tests are negative, but the patient has heart related complaints. So basically it is to rule out coronary artery disease in patients who are less likely to have coronary artery disease. In her case, since there is a strong suspicion of coronary artery disease, conventional Anglo must be done. Also, CTA is not very good at quantifying the severity of a block. Also, even if she undergoes a CTA, and some blocks are diagnosed (which will come up in her case), the next step would be a conventional angiogram. So the ideal way to proceed from here is a conventional angiogram and definitely not a CTA. Wishing her good health. Regards