Question: Hi, I was recently hospitalized for 5 days, and the following are exerts from my medical record. Pls tell me your findings, as they did not say very much to me, which is amazing. I am highly stressed with all of this. Should I even be working? XXXXXXX
Active Problems
•     Chest pain (Noted 12/5/2014)
•     Depression with anxiety (Noted 12/8/2014)
•     Diabetes mellitus (Noted 12/5/2014)
•     She has known history of LBBB
Procedures
•     ECHOCARDIOGRAM TRANSTHORACIC COMPLETE W/ COLOR FOW (Performed 12/8/2014)
•     CARDIAC XXXXXXX PROCEDURE (Performed 12/8/2014)
•     STRESS TEST, PHARM W/ NUC CARDIAC MUGA (Performed 12/6/2014)
•     CRITICAL CARE (Performed 12/5/2014)
•     CRITICAL CARE (Performed 12/5/2014)
Procedure
A complete two-dimensional transthoracic echocardiogram was performed (2D, M-
mode, spectral and color flow Doppler).

Interpretation Summary
Ejection Fraction is 65 %.

Ao root diam: 2.5 cm (2.0 - 3.7 cm)
LA dimension: 3.4 cm (1.9 - 4.0 cm)
IVSd: 0.84 cm (0.6 - 1.1 cm)
LVPWd: 0.84 cm (0.6 - 1.1 cm)
LVIDd: 3.7 cm (3.8 - 5.6 cm)
LVIDs: 2.0 cm (2.0 - 4.0 cm)
(<3.3 cm)

Doppler Measurements & Calculations
Ao V2 max: 181.9 cm/sec LV V1 XXXXXXX PG: 5.6 mmHg
Ao XXXXXXX PG: 13.2 mmHg LV V1 mean PG: 3.1 mmHg
Ao V2 mean: 141.4 cm/sec LV V1 max: 118.6 cm/sec
Ao mean PG: 8.5 mmHg LV V1 mean: 81.5 cm/sec
Ao V2 VTI: 41.8 cm LV V1 VTI: 26.4 cm
PA V2 max: 68.1 cm/sec
PA XXXXXXX PG: 1.9 mmHg

Left Ventricle:
The left ventricular size, thickness and function are normal. Ejection
Fraction is 65 %. LV diastolic function is unable to be assessed due to
arrhythmia.

Right Ventricle:
The right ventricle is normal in size and function.

Aortic Valve:
No aortic regurgitation is present. No hemodynamically significant valvular
aortic stenosis.

Mitral Valve:
The mitral valve is normal in structure and function.

Tricuspid Valve:
The tricuspid valve is not well visualized, but is grossly normal. There was
insufficient TR detected to calculate RV systolic pressure.

Pulmonic Valve:
The pulmonic valve is not well visualized.

Pericardium:
There is no pericardial effusion.

STARTWALLMOTION

ENDWALLMOTION
Electronically signed by: XXXXXXX Fischi, MD,FACC, FSCAI on 12/08/2014 06:29
PM

Study Information:
00354 - NM CARDIAC GATE SPEC IMG EFWM Accession # 0000
Study Date: 12/06/2014 10:41

Comparison: None

Indication: Chest Pain

Intra-procedural medications: The patient received Technetium-99m
Sestamibi - IV - 12 - mCi - Left Antecubital - 0700 - DRC
Technetium-99m Sestamibi - IV - 36 - mCi - Left Antecubital - 0945 - VM


Findings:
The patient was stressed by intravenous infusion of Lexiscan. Stress
myocardial tomographic images performed following intravenous injection of
36mCi Tc99m Sestamibi demonstrate a mildly abnormal summed stress score of
five extending from the apex to the base of the septum. Elsewhere, there
is a normal pattern of tracer accumulation in the left ventricular
myocardium. The left ventricular chamber is not dilated.

At rest, 12 mCi of Tc99m Sestamibi was injected intravenously. Myocardial
tomographic images at this time demonstrate a normal pattern of tracer
accumulation in the left ventricular myocardium.

TID is 1.01 .

IMPRESSION:
Mild ischemic changes along the septum. I reviewed this study on the
Pegasys workstation. The patient is not obese and does not have large
left anterior chest wall soft tissues to cause attenuation artifact in
this region.

GATED IMAGING AND EJECTION FRACTION:

Findings:
Review of the gated images demonstrates decreased wall motion with an
ejection fraction calculated to be 37 %.
IMPRESSION:

Decreased wall motion with a left ventricular ejection fraction of 37 %.

Dictating Radiologist: XXXXXXX Teixeira Sat Dec 6 12:10:17 EST 2014
Transcribed by:John TeixeiraSat Dec 6 12:10:17 EST 2014
Approved by:John TeixeiraSat Dec 6 12:10:17 EST 2014

ED Course
ECG 12 Lead

Date/Time: 12/5/2014 3:54 PM
Performed by: WATSON, XXXXXXX L.
Authorized by: WATSON, XXXXXXX L.
Interpreted by ED physician
Comparison: compared with previous ECG
Comparison to previous ECG: LBBB is not new.
Rhythm: sinus rhythm
Ectopy: frequent PVCs
Rate: normal
QRS axis: left
Conduction: left bundle branch block
Clinical impression: abnormal ECG

XXXXXXX L. Watson, MD 12/5/2014 8:09

I am a hurricane XXXXXXX survivot from Louisiana , and I have PTSD, anxiety and panic, I am an nurse that sits on the phone all day hearing complaints from customers from a private insurance company, I have been doing this for 8 years, I just cannot do it anymore, they yell, scream, and threaten, there is no time off the phone, my heart cannot take it anymore. I am asking one of my doctors to write that I should not be working with all of this. Pls tell me your opinion on the ventricular fraction rate of 37, I am having a hard time understanding why the hospital did not write down anything about not going back to work. I am just amazed. Do you work in XXXXXXX or another country?? XXXXXXX

What does a left ventricular fraction rate of 37% mean, my feet turn blue sometimes, i have intermittent slight edema in my lower legs, not too often, and major confusion, is this all related to this problem?
What does ischemic heart disease mean to me.....pls be specific. thx XXXXXXX