pt gives great narrative --> an abnormal EKG but no symptoms prompting stress...stress self-reportedly normal...cardiologist said "was something electrical misfiring", ? current bundle branch blocks
pt A--luck out and GET old records. pt had STEMI (!!), heparin/integrillin, 40% proximal LAD lesion, ECHO w low normal EF w mid anterior and apical hypokinesis to akinesis
pt B--quick attempt (ie Epic link to out-of-state) finds no leads on tracking down records
pt A-elective surgery, refer to cardiology 4 testing (v order stress myself) & to reestablish for CAD (40% prox LAD lesion) that has been lost to fu (no statin/aspirin)
pt B-time-sensitive surgery, no testing/referral. Non-spec EKG changes, long-standing, >> 4 METS
"I've had 5 prior stress tests for annual screening until my new PCP stopped" diff from MI/cath ~40yo!