I can definitely relate. I have a CAC score in the 98th percentile and run/cycle and lift weights regularly. I don't know much about angina, though. I get various pains similar to yours when I work out and it always bothers me knowing I have some atherosclerosis in my coronary arteries. I don't know how to decide when it's time to get checked out. Everything you see online says that if you are concerned, it's better to be safe than sorry.

For myself, I've watched a lot of videos about people describing their heart attacks to try to know what to look for. I've also watched videos of doctors describing when it is likely/less likely to be a heart attack. It seems to me that the discomfort is significant and there often is more than just pain (sweating, out of breath, ...). I gather if it gets worse with exertion, then that's a troubling sign. But that is very subjective. Again for myself, if it's transient, less than a minute or two say, or not severe, I ignore it. A few times I got worried while running because it was more severe than usual and seemed to get worse with exertion, but I just stopped and walked and paid close attention, and decided it wasn't serious. I'm still here. 🙂 But I don't know how one can know.

On the plus side, I believe a LAD score of 7 is on the low side. Sounds like your doctor is on top of it.