45-year-old lady for hysterectomy
- Smoker – cigarettes and marijuana
- Laparoscopic salpingectomy recently, no issues
- Ex heavy ETOH
- Very difficult social situation
- Intermittent chest pain
- Challenging history
- Atypical and self-limiting
- Weekly, Exacerbated by stress
- DASI > 4 METs
- Normal ECG, no other cardiac investigations
- NYHA class 3 dyspnoea
- Regular Ventolin use
- No admissions or steroids
- Unable to afford preventer
- Normal spirometry
- weekly seizures, improved from previous
- GP managing as currently awaiting neurologist appt.
- Letter from gynaecologist – try progesterone therapy first
- Uncertain as to why has been listed for surgery
- Hb 120, ferritin 36
- Cardiac Stress Test indicated?
- Difficult decision, low-risk surgery.
- Patient not keen for further investigations despite risks and benefits being outlined in clinic
- GP has written medical certificate at patients request stating that chest pain is stress-induced and not angina-related.
- Respiratory consult
- Stable asthma
- Not compliant with preventer therapy – encouraged to do same
- Discussion with GP regarding need for cardiac investigations
- Discuss with gynae surgeon – elucidate reason for procedure.
- Smoking cessation
- Recommence asthma preventer
- Social work support