{"text":"NHS Confidential: Personal data about a patient \nNorwood Henry CHI: 0101506015 OPCL 03\/12\/2024 v1 \nToday he is describing some limiting symptoms. His main symptom on exertion is breathlessness \nwhich can be preceded by chest pain and quickly settles with rest within a few minutes. He tells me \nafter a degree of moderate exertion he checks his pulse oximeter and this shows sats of 85% and \nthis seems to be associated with him having chest pain symptoms. His oxygen saturations quickly go \nup again to 92% at rest with full resolution of his chest tightness. He also reports another type of non- \ncardiac pain which feels like cramp worse with movement in his chest and eases with stretches. This \ncan also be continuous and long lasting and not consistent with cardiac ischaemic pain. He tells me \nthat his GTN spray does not help with the pain and gives him a burning sensation under the tongue, \ntherefore he has not been using that lately. He is denying other heart failure symptoms such as leg \nswelling, significant orthopnoea or paroxysmal nocturnal dyspnoea. \nHis blood pressure was 143\/64mmHg and his heart rate was 62bpm regular. His chest x-ray was \nclear and he was clinically euvolemic. \nTaking everything into consideration, it is difficult to fully distinguish his symptoms from his COPD and \nischaemic symptoms. However, | do feel that this might represent anginal symptoms although unclear \nif it is caused by fixed coronary obstruction or triggered and compounded by hypoxia. Unfortunately \nhe continues to smoke which will clearly impact on consideration of oxygen therapy. \n| elected to optimise his anti-anginals for better symptom control today, so | reduced his Ramipril \nfrom 5mg to 2.5mg to allow room for Amlodipine 5mg. With regards to his prognostic medication his \nLDL in September 2023 was 3.0 and he had been switched to Rosuvastatin 5mg since, so | would \nappreciate if this can be repeated at your practice and increase the statin accordingly to achieve \noptimal LDL of <1.4, \nWe should aim to optimise him medically as much as we can however if his current symptoms persist \nand there is still dubiety with regards to epicardial flow limiting lesion, then a repeated invasive \ncoronary angiogram could be considered in the future with physiological assessment, sending him for \nnon-invasive functional imaging before sending him for repeat angiography. \nMr Norwood has currently a follow up appointment with Dr Robertson in June 2025, so | have \ndischarged him from the Hot Clinic today. \nYours sincerely, \nDr Angelo Santos \nST6 Cardiology \nPrinted on 13\/12\/2024 10:50 by Senga Meenagh Page 2 of 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