Cardiology Consult

I had the pleasure of seeing John Smith today. He is a pleasant 58-year-old male that was referred for cardiac assessment. **CARDIAC RISK FACTORS** Increased BMI: Yes Hypertension: Yes Dyslipidemia: Yes Diabetes mellitus: No Smoker: 20 pack-years, smoked for 25 years, 10 cigarettes per day Ex-smoker: Quit in 2015 Family history of atherosclerotic disease in first-degree relatives: Father had a myocardial infarction at age 54 **CARDIAC HISTORY** Coronary artery disease with previous angioplasty in 2018 **OTHER MEDICAL HISTORY** Appendectomy in 1990 **CURRENT MEDICATIONS** Antithrombotic Therapy: Aspirin 81 mg daily Antihypertensives: Lisinopril 20 mg daily Heart Failure Medications: None known Lipid Lowering Medications: Atorvastatin 40 mg daily **ALLERGIES AND INTOLERANCES** Penicillin (rash) **SOCIAL HISTORY** John lives with his wife in a suburban area. He has two adult children. He is retired and enjoys gardening. Smoking history as above. He drinks alcohol socially, approximately 2 drinks per week. He has a private health plan. **HISTORY** John presented with occasional chest discomfort during exertion. He denies any shortness of breath or palpitations. He walks 30 minutes daily without significant issues. "Review of systems is otherwise non-contributory." **PHYSICAL EXAMINATION** Blood pressure: 130/85 mmHg, Heart rate: 72 bpm, Oxygen saturation: 98% on room air. Precordial examination was unremarkable with no significant heaves, thrills or pulsations. Heart sounds were normal with no significant murmurs, rubs, or gallops. Chest was clear to auscultation. No peripheral edema. **INVESTIGATIONS** Laboratory investigations: CBC (1 November 2024): Normal, Lipids (1 November 2024): Elevated LDL ECGs: (1 November 2024): Normal sinus rhythm Echocardiograms: (1 November 2024): Mild left ventricular hypertrophy **SUMMARY** John Smith is a pleasant 58-year-old male that was seen today for cardiac assessment. Cardiac risk factors include increased BMI, hypertension, dyslipidemia, and a family history of early myocardial infarction. He has a history of coronary artery disease with previous angioplasty in 2018. **ASSESSMENT/PLAN** #1 Coronary Artery Disease Assessment: Stable with occasional exertional chest discomfort Plan: Continue current medications. Recommend a stress test to evaluate exercise tolerance and ischemic changes. Encourage lifestyle modifications including diet and exercise. Follow-up in 3 months or sooner if symptoms worsen. **FOLLOW-UP** Will follow-up in due course, pending investigations, or sooner should the need arise. "Thank you for the privilege of allowing me to participate in John Smith's care. Feel free to reach out directly if any questions or concerns."