Coronary Artery Disease follow-up

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Returns for a ‍coronary artery disease follow-up

Cardiac history reviewed: ‍coronary artery disease, ‍myocardial infarction, ‍angina, ‍catheterization, ‍‍heart failure,

Last visit was ‍ ‍months ago

Progress since last visit: ‍unchangedimprovedworsenedvariable in intensityresolved



Current symptoms:

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath

‍fatigue

‍decreased exercise tolerance

‍dizziness

‍palpitations

‍syncope

‍lower extremity edema, ‍rightleftsymmetrical

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍orthopnea

‍paroxysmal nocturnal dyspnea



Impact on daily activities: ‍minimalmoderateseveredebilitating

Overall quality of life: ‍goodaveragepoor ‍

Cardiac rehabilitation program: ‍completedenrolledabandonednot interested ‍



Diet: ‍goodaveragepoor, ‍high in salt, ‍high in carbs, ‍high in fat, ‍vegan

Physical activity: ‍adequateaveragesedentary

Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonereasonableexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU



ECG: ‍ ‍normal

Echocardiogram: ‍ ‍unremarkable

Stress test: ‍ ‍normal

Coronary angiogram: ‍ ‍normal



Medications:

‍Aspirin, ‍Clopidogrel, ‍statins, ‍Beta blockers, ‍ACE inhibitors, ‍ARBs, ‍Calcium channel blockers, ‍Nitrates

Adherence: ‍goodaveragepoor

Use of rescue nitroglycerin: ‍neverrarelyfew times monthlyfew times weeklydaily



Vaccinations:

Pneumococcal: ‍up-to-dateincompleteunvaccinated

Influenza: ‍up-to-dateincompleteunvaccinated

Covid: ‍up-to-dateincompleteunvaccinated





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Metrics: weight: ‍ ‍kglbs, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Coronary artery disease ‍likelysuspectedpossible, ‍well-controlled

DDx: stable angina, unstable angina, myocardial infarction, coronary artery spasm, silent ischemia, atypical chest pain, pericarditis, aortic stenosis, hypertrophic cardiomyopathy, heart failure, arrhythmias, anemia, thyroid disease, pulmonary embolism, pulmonary hypertension, esophageal spasm, GERD, peptic ulcer disease, panic attack, musculoskeletal pain





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍HbA1c, ‍lipid profil, ‍TSH, ‍troponin

- Urinalysis

- ECG

- Stress test

- Echocardiogram

- Coronary angiogram

Treatments:

- ‍Antiplatelets

- ‍Nitroglycerin

- ‍Statins

- ‍ACEs

- ‍ARBs

- ‍Beta-blockers

- ‍Calcium-channel blockers

- ‍Diuretics

- Lifestyle counseling: sodium restriction, healthy diet, increase exercise, weight loss

- Smoking cessation

- Home blood pressure monitoring

- Immunizations: ‍annual influenza, ‍pneumococcal

Further care:

- Referral to cardiac rehabilitation program

- Referral to cardiologist

- Follow-up in ‍ ‍monthsyears