Can a nuclear stress test miss something, for someone who is symptomatic at high level of activity, and have about 40% lad ( previous cath ) ? is this test perfect ? thanks drs.

Not perfect: People can pass nuclear stress tests with 50% lesions. Did you reach your target heart rate during the stress test? The gold standard for diagnosis is the angiogram and yours demonstrated a 40% lad blockage. Your cardiologist is best qualified to determine whether angioplasty, bypass surgery or watchful waiting is best for you. In the meantime you're on ?statin,aspirin,betablocker,,ngn as needed

Not perfect: Would need to know the reason for the test. Was it for new pain in which case gold standard is angiogram vs was it to look for inducible ischaemia in the area of concern supplied by that 40% LAD to decide on whether needed intervention. Best to ask a cardiologist or the doctor that ordered the test what exactly they were looking for to answer re suitability of test vs need for alternative.

Stress test: The nuclear test is better than a tradiitonal exercise stress test but not perfect. Catheterization is the best test to assess the coronary arteries. Hope that helps.