Internal Medicine Telehealth Consultation Note

Date of Consultation: 2025-05-21  
Time: 13:13 - 13:45  
Mode: In-person  

DIAGNOSES:  

1. Unstable Angina  
2. Hypertension and Hypercholesterolemia  

RECOMMENDATIONS:  
The patient requires urgent inpatient care to expedite cardiac catheterization due to worsening angina symptoms.  

1. Admit the patient for inpatient care to facilitate cardiac catheterization.  
2. Continue current medications, including nitroglycerin patch and spray, metoprolol, candesartan, and amlodipine.  

Dear Referring Provider,  

I saw Margaret Ellison on 2025-05-21 to review her worsening angina symptoms.  

HISTORY OF PRESENTING ILLNESS:  
Margaret Ellison is a 59-year-old female with a history of angina pectoris, hypertension, and hypercholesterolemia. She reports a significant worsening of her angina symptoms over the past few months. Initially, her chest pain occurred only with exertion and lasted up to 15 minutes. However, she now experiences chest pain with minimal exertion, such as walking short distances or performing household tasks. She is unable to walk more than a couple of hundred meters without experiencing chest pain. She denies any changes to her medications or increases in dosage. The symptoms have significantly impacted her daily activities and quality of life.  

She underwent an exercise stress test in February, which was positive, showing chest discomfort and new onset left bundle branch block at three minutes of a standard Bruce protocol. Both chest pain and the left bundle branch block resolved within two minutes of cessation of exercise. She has been awaiting cardiac catheterization since the stress test.  

REVIEW OF SYSTEMS:  
Cardiovascular: Reports worsening chest pain with minimal exertion. Denies episodes of pain at rest initially.  
Respiratory: No shortness of breath reported.  
Gastrointestinal: No nausea or vomiting reported.  
Neurological: No dizziness or fainting reported.  

MEDICATIONS:  
• Enteric-coated aspirin 81 mg once daily  
• Nitroglycerin patch 0.2 mg per hour once daily  
• Metoprolol 12.5 mg orally twice daily  
• Pantoprazole 40 mg once daily  
• Candesartan 24 mg once daily  
• Imatinib 400 mg once daily  
• Amlodipine 2.5 mg once daily  
• Nitroglycerin spray as needed  

PHYSICAL EXAMINATION:  
During the in-person assessment:  
• She appeared well-nourished and in no acute distress.  
• Cardiovascular: Normal heart sounds without murmurs or added sounds. No jugular venous pressure elevation. Apex beat not displaced.  
• Respiratory: Chest clear.  
• Abdomen: Non-tender.  
• Neurological: No abnormalities.  

ASSESSMENT:  
I've made the recommendations as noted above.  

Thanks once again for involving me in the care of this pleasant patient.  

With regards,  
Transcribed with voice dictation software.  
Edward Collins, MD, FRCPC  
Regional Medical Clinic