HISTORY: This is a 55-year-old gentleman who comes with complaints of chest discomfort radiating to his right arm. It lasts a few seconds
CORONARY RISK FACTORS: Positive diabetes, positive (1) __________ . Negative smoking, negative family history, and negative hypertension.
MEDICATIONS:
1. Glyburide.
2. Simvastatin.
3. (2)__________.
PROTOCOL: Standard (3)__________ protocol.
RESTING EKG: PR interval 0.16. (4)__________ interval 0.06. Axis +90 degrees.
Interpretation: Sinus rhythm, rate of 70. Poor R-wave progression, cannot exclude previous (5)__________ myocardial infarction, age undetermined; nonspecific ST and T-wave abnormalities.
RESULTS: The patient exercised for 6 minutes 22 seconds, achieving a maximal heart rate of 148, which was 90% of his maximal (6)__________ heart rate. He achieved 7.5 (7)__________ of exercise.
Blood Pressure: Initial resting blood pressure was 140/90 and rose to a peak of 190/80 at peak exercise. It then decreased to 140/70 three minutes into the recovery phase. His double product was 28,100.
Symptoms: The patient experienced (8)__________ and shortness of breath while on the treadmill, but denied any chest tightness complaint.
Reason for Stopping: Fatigue.
STRESS EKG: At approximately 3 minutes into the treadmill trial, the patient developed 1 to 1.5 mm of horizontal and downsloping ST depression noted in V4 and V5. These EKG changes progressed to a full 2 mm of horizontal ST depressions in those leads. These EKG changes resolved within 3 minutes of recovery phase.
Arrhythmias: An occasional PVC was seen. There were no episodes of (9)__________, PACs, or supraventricular tachycardia.
IMPRESSION:
1. Fair exercise tolerance.
2. Normal blood pressure response.
3. Negative for the development of chest discomfort.
4. (10)__________ positive for ischemia.
1. hypercholesterolemia
2. Glucophage
3. Bruce
4. QRS
5. anterior wall
6. predicted
7. METS
8. fatigue
9. ventricular tachycardia
10. Electrocardiogram
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