<s>[INST] First, I failed the stress test.  The Doctor seemed very concerned that my heart rate was so high after 2 minuets on the tredmill.  My question is that after doing a cardio exercise for about 1 minuet, my heart rate went to 150 and there was no immediate ache but at some point durning the night, I had a dull ache in the heart.  Could there be any other concern?  I had the procedure where they went in to check for blockage.  There was none. My age is 46 and I am approx 275lbs [/INST] Hi, welcome to Chat Doctor. Thanks for writing to us.First, you failed in the stress test, that means the TMT test was positive for inducible ischemia. So there is some concern. There are certain risk factors for the development of coronary artery disease(heart attack), these are:1.waist circumference >40 inches(men)2.triglyceride>150 mg /dl3.HDL cholesterol4.BP>130/85 mm of hg5.fasting blood sugar>110 mg/DL If 3 or more risk factors are present in your case. Chance of developing CAD is much higher.  So, you should first go for the following tests:1.lipid profile2.fasting blood sugar3.complete blood count4.EKG5. Repeat ANGIOGRAPHY(procedure to check for blockage) if necessary. Hope I have answered your query. Stay fit, good luck. </s>