HISTORY: This is a 45-year-old female who has been requested to see me for Cardiology consultation. She currently denies any chest pain, shortness of breath, dizziness, lightheadedness, palpitations, syncope, or abdominal pain. She also denies any recent alcohol intake or smoking. She states that she is on no medical therapy at the present time. She does give a history of chronic elevated cholesterol on no medical therapy along with a history of underlying obesity. She is currently awaiting gastric surgery secondary to her underlying obesity. She uses a cane in order to ambulate secondary to bilateral knee pain.

A chest x-ray in August 2005 was interpreted by Radiology as showing no infiltrates while laboratory data form September 2005 revealed cholesterol of 225, triglycerides 130, and HDL of 42 with an LDL of 184.

An EKG in 2004 revealed sinus rhythm pattern while a followup EKG performed on August 3, 2006 revealed underlying sinus rhythm pattern without any changes.

PHYSICAL EXAMINATION: Exam reveals a 45?year?old obese female in no acute distress. Blood pressure is 122/80 mm Hg. Heart rate is 72 per minute and regular. Respiratory rate is 16 per minute and regular. Neck exam reveals no evidence for any mass or JVD. Examination of the eyes, teeth, and oral mucosa do not reveal any significant abnormalities. Lungs are clear to auscultation. Heart exam reveals S1, S2 regular without any murmur or thrill. Abdomen is soft with positive bowel sounds. Extremities reveal bilateral decreasing edema and/or without clubbing. Neurologically, the patient is oriented to time, place, and person and neurological exam is grossly intact. Peripheral artery pulses are equal and bilateral.

IMPRESSION: The patient is a 45-year-old female with a history of elevated cholesterol along with obesity.

TREATMENT PLAN: She will continue to attempt to lose weight and follow a strict low-salt, low?cholesterol diet and will continue to follow up with her medical doctor for checks of her blood pressure, serum electrolytes, and serum lipid profile analysis. As noted above, she is currently being evaluated for gastric surgery secondary to underlying obesity. She will be referred for an echocardiogram to assess left ventricular function and to also evaluate for any abnormal valve pathology.

She will also be sent for an intravenous Persantine thallium stress test to rule out cardiac ischemia. If the stress test and echo do not show any significant abnormalities, then she will be able to undergo her proposed surgery from a cardiac standpoint. I would recommend EKG monitoring during surgery for any signs or ischemia and/or arrhythmias. I would also recommend cautious intravenous hydration with close monitoring for any signs of CHF and/or fluid overload. The patient is aware of possible cardiac complications in the perioperative period including CHF, MI, angina, arrhythmias, sudden cardiac death, and she will accept any such risk. She will also have routine medical evaluation as well prior to surgery. As noted above, she will be referred for an echocardiogram and a stress thallium from a cardiac standpoint prior to her proposed gastric surgery.

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