Coronary artery bypass operations

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David Lassee is a 67-year-old man with coronary artery disease. He has had two coronary artery bypass operations. He has been seen on several occasions recently because of frequent angina. A coronary angiogram performed 1 month ago revealed significant disease in the RCA proximal to his graft, but this was considered high risk for angioplasty. His dose of isosorbide mononitrate was increased at that time from 60 mg to 120 mg once daily. This had no effect on his angina. He is still using approximately 30 nitroglycerin tablets a week,and these do relieve his chest pain. He reports that most often the chest discomfort comes on with activity, such as walking. The discomfort is located in the center of his chest and rated as a 3-4 out of 10 on average. He reports that the chest discomfort slowly fades as he slows his activity. He also complains of occasional lightheadedness, with a pulse of around 50 beats per minute and SBP near 100 mm Hg.

Reference no: EM133364667

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