I've recently come across my TMT results, which show a mildly positive reaction with horizontal ST depression up to 2mm in some leads, but it normalizes quickly in recovery. My echo came out normal, and I don't smoke, drink, or have any early CAD family history. My lipid profile reads LDL at 101, triglycerides at 139, HDL at 33, and a total of 157. I'm quite sedentary, and lately, I've noticed pinpoint pain and pressure in my chest, shoulders, and upper abdomen. It flares up intermittently during brisk walking and feels really localized. I've also been dealing with anxiety for the past four years, so I sometimes have breathing difficulties whether I'm resting or active. Is it possible to have CAD at this age without any obvious risk factors, or could this pain just be anxiety? I did have stress echo tests in the past, which were negative, just like a TMT back in 2016. Could you offer some insight?

Given your history of chest painpressure, especially with brisk walking, and the findings on your recent TMT showing mildly positive results with horizontal ST depression, it is important to consider the possibility of coronary artery disease (CAD) even in the absence of traditional risk factors. The fact that the ST depression normalizes within 15 seconds of recovery is somewhat reassuring, but further evaluation is warranted. Considering your symptoms and history of anxiety, it is also possible that the chest pain you are experiencing could be related to anxiety. However, it is crucial not to dismiss the possibility of CAD, especially with the new onset of localized chest pain and your TMT results. Given your overall profile and symptoms, I would recommend further evaluation by a cardiologist. They may consider additional tests such as a coronary angiogram to assess the extent of any possible blockages. In the meantime, it is important to continue monitoring your symptoms and seek medical attention if they worsen or become more frequent. In terms of medication, based on your lipid profile, a statin medication such as Atorvastatin (10-20mg) may be considered to help lower your LDL cholesterol levels and reduce the risk of CAD progression. Additionally, medications to manage anxiety such as Escitalopram (10mg) may be prescribed to help alleviate your symptoms. It is important to address both the cardiac and psychological aspects of your symptoms to ensure a comprehensive treatment approach.