In suspected ischemic heart disease, when is coronary angiography indicated?

• A. As initial test
• B. After ECG shows signs of ischemia
• C. Only if troponin negative
• D. Never

Answer: (B)

Coronary angiography is reserved for when there is objective evidence of ischemia, because it is an invasive test used to define the exact coronary anatomy and guide revascularization. In suspected ischemic heart disease, you first use noninvasive assessments (like ECG and stress testing) to detect ischemia. If those tests show ischemia on ECG, that indicates a high likelihood of obstructive CAD and warrants coronary angiography to identify lesion details and plan treatment such as PCI or CABG. Troponin status alone doesn’t decide the need for angiography, and the test isn’t done as the initial step or never performed.