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He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. In the meantime, cardiology consultant sees the patient and performs a bedside echocardiogram which revealed no major wall motion abnormalities. He has 40 packs-year of smoking history. He denies taking any medication.
His exercise capacity was good at 11 METs, stopped at early stage 4 standard Bruce. Mostly, you can’t escape from a coronaryangiogram” Next option is CT angiogram, Thallium or dobutamine stress. Out of 5 cardiologists I consulted, 4 asked me to go for an immediate angiogram. This is the test he did.
Previously healthy, taking no medication and exercising regularly. No anginal symptoms asymptomatic during physical exercise. CT coronaryangiogram showed a hypoplastic RCA and dominant LCx. It is reasonable to perform an echocardiogram to evaluate LV function. Below in Figure-1 is this patient's admission ECG.
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Coronary Angiogram 
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