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Clinical Information
Case Study: 75-year-old Caucasian Male With One
Month History of Chest Discomfort With Exertion
History
- 75-year-old Caucasian male with one month history of chest discomfort
with exertion. This is associated with increased exertional dyspnea.
The patient attests to some mild exertional dyspnea after walking
two flights of stairs, which has been evident for the past year
- Past medical history: hypertension, hyperlipidemia, small abdominal
aortic aneurysm measuring 3.8 cms, BPH
- Habits: 2 packs of cigarettes daily between the age of 16 to
40
- Allergies: lisinopril
- No unusual hobbies or pets
- Prior occupation: Attorney
- Current medications: atorvastatin 20 mg a day, diltiazem 240
mg daily, aspirin 325 mg daily
Physical Exam and Work-up
- PE: Vital signs stable, patient in no distress with RR of 18/min.
SpO2 97% on room air. No clubbing noted
- Chest exam is clear
- The patient is referred to a cardiologist and a cardiac work-up
is initiated with a positive exercise stress test
Tests
- A cardiac catheterization is performed 2 days later
- Severe left main trunk disease with 95% distal left main stenosis,
50% proximal left anterior descending artery stenosis
- The patient is admitted for urgent CABG the next day
- A pre-operative CXR is performed
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