Do you need an angiogram if your stress echo is normal?

Typically not.: Depending on other clinical factors such as cardiac risk factors, and symptoms, a normal stress echo may complete the evaluation. In some cases, even in the case of a normal stress test, there could be some scenarios in which an angiogram could still be a consideration - such as lack of alternative cause of symptoms, or worsening/change/nonrelief of symptoms.

Need for angiogram: Not sure what the indications for a stress Echo in someone 21 years old were as the likelihood of coronary artery disease is extremely low. If the stress Echo was normal this has a good accuracy for predicting no significant coronary artery disease and therefore invasive testing with an angiogram would not be indicated.

Unlikely: No stress test is 100% accurate. However, at your age with a normal stress echocardiogram it is unlikely you have coronary artery disease. However, the only way to definitively determine is with a coronary angiogram. If you continue to have symptoms I would follow up with your local doctor or cardiologist.