Conversation: The conversation between human and AI assistant.
[|Human|] Hello,i worked TMT test by Bruce protocol. results are : test were stoped in 11 minute, with 12,0 METS. In inferior lines in D3 there are st horizontal depression up to 2,1 mm, while submaximum pulse. Pacient whitout angious pains, and with objective fatigue. max HR was 171 (89 %)...HRR -35 / min. in recovery faze EKG is normal. Patient is 192 cm, 80 kg, without heritage heart problems, whit no diabetes, fats, BP is normal ( 120 /80 ) and 28 years old. in history he was athlete. In past few months or year he feels fatigue while walking, or walking up to hill is realy hard for him. Blood test are normal.Doctors are for coronography. What do you think abouth it ? Sorry for my english.Thank you, Regards !
[|AI|]  Don't worry about your English, the information that you provided is quite complete. Ill break down your question into some key components.1. A 28-year-old with physical limitation unusual for him. The probability of coronary heart disease is low but not zero and the treadmill provides useful information. It lets you know that his limitation is not severe and risk of near term death is not high affording time for deliberation, elective evaluation and choices in the next step for arriving at a diagnosis.2. The ECG is abnormal in D3 (frontal plane lead III) with exercise but rapidly returns to normal. This is frequently a false positive finding and does not automatically indicate arterial disease.3. The treating physicians are sufficiently suspicious to recommend invasive testing. Oddly, one of the most difficult things to test in medicine but also one of the most important, is the physicians' suspicion after interview and examination. Therefore, the recommendation to look for additional information should be followed. The options that should be discussed with the treating doctor (to be sure that he or she has the information needed to make good decisions) are 1. Additional physiological testing performed with imaging methods such as nuclear imaging or echocardiography.  2. Non-invasive angiography using CT scanning.