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Reason for Consultation: Surgical evaluation for coronary artery disease History of Present Illness: The patient is a 47-year old male who has a known history of coronary artery disease. He underwent previous PTCA and stenting procedures in December and most recently in August. Since that time, he has been relatively stable with medical management. However, in the past several weeks, he started to notice some exertional dyspnea with chest pain. For the most part, the pain subsides with rest. For this reason, he was reevaluated with a cardiac catherization. This demonstrated 3- vessel coronary artery disease with a 70% lesion to the right coronary artery; this was a proximal lesion. The left main had a 70% stenosis. The circumflex also had a 99% stenosis. Overall left ventricular function was mildly reduced with an ejection fraction of about 45%. The left ventriculogram did note some apical hypokinesis. In view of these findings, surgical consultation was requested and the patient was seen and evaluated by Dr. Isaacson.
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