Cardiology Consult Note

Cardiology Consult for Dr. Anya Sharma, Cardiologist Reason for Consultation: Patient presenting with acute chest pain and shortness of breath. Referred from the Emergency Department for evaluation of possible cardiac etiology. History of Present Illness: Patient, a 68-year-old male, reports sudden onset of severe, crushing chest pain radiating to the left arm, which began approximately 2 hours prior to presentation. Associated symptoms include shortness of breath, diaphoresis, and nausea. The pain has not been relieved by rest or sublingual nitroglycerin. Cardiac History: - History of hypertension - Previous myocardial infarction 5 years ago - Underwent percutaneous coronary intervention (PCI) with stent placement in the left anterior descending artery (LAD) PMHx: - Hypertension - Hyperlipidemia - Type 2 Diabetes Mellitus Meds: - Aspirin 81mg daily - Metoprolol 50mg twice daily - Lisinopril 20mg daily - Atorvastatin 40mg daily - Insulin glargine 10 units subcutaneously at bedtime FHx: - Father: History of coronary artery disease, died at age 70 - Mother: History of hypertension Social: - Smoker: 1 pack per day for 40 years - Alcohol: Occasional use - Exercise: Sedentary lifestyle - Occupation: Retired accountant O/E: - BP: 160/90 mmHg, HR: 110 bpm, RR: 24 breaths/min, SpO2: 92% on room air - General: Appears acutely ill, in distress - Cardiovascular: S1 and S2 present, no murmurs, rubs, or gallops. Elevated JVP. - Lungs: Bilateral crackles in the bases. Ix: - ECG: ST-segment elevation in leads II, III, and aVF. - Cardiac enzymes: Elevated troponin I. - Chest X-ray: Mild pulmonary congestion. Impression: Acute ST-elevation myocardial infarction (STEMI). Plan: - Immediate transfer to the cardiac catheterization lab for emergent PCI. - Administer oxygen, aspirin, and heparin. - Continue monitoring of vital signs and cardiac rhythm. - Cardiology to manage post-procedure. - Follow up in cardiology clinic in 2 weeks. - Patient education on lifestyle modifications, including smoking cessation and dietary changes. - Discussed the need for cardiac rehabilitation.