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A 66y old Physician, walked into my OPD and said he's fine and fit but his daughter is insisting that he should see a Cardiologist. He said he feels something weird from him neck to his abdomen after taking a hot bath and after short walks but - "IT IS NOT CARDIAC" he declared.
I had to tread carefully here. He also had OCD on meds. I said yeah you look fine Sir! Let's just get a basic check so that your daughter is satisfied. Advised an ECG Echo TMT. ECG and Echo were normal and on TMT he just walked 2 min and said I'm tired. #MedTwitter #cardiotwitter
He again said I'm fine! Just little tired and kept holding his chest. I said just do a CT Coronary calcium score it's a 5 minutes job. If it is normal I'll send you home right away! #CTCalciumscore was done and showed extensive calcification of all Coronary arteries.
Advised a coronary angiography. He got admitted the next day and angio showed critical left main disease and triple vessel disease. #leftmainCAD
Advised Bypass surgery in view of Diabetes and Calcific Left main + TVD. He wanted a 2nd opinion for which I suggested a couple of places too. He took the second opinion and got readmitted after 2 days. #secondopinion (learnt the art of communication from @serioustaurean largely)
Any elective non-emergency situation, one is entitled for a second opinion. This article covers few aspects. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=2708
He underwent a CABG successfully. Went home after a week with an uneventful recovery. He agreed that he would have probably not agreed if I wasn't systematic and slow in my approach. He had already walked out of another Cardiologist's office after an advice for angiogram!
CABG vs PCI for left main coronary artery disease
