Cardiac imaging modalitiesDownloads

A 57-year-old man presents to his family physician for a routine exam. He feels well and reports no new complaints since his visit last year. Last year, he had a colonoscopy which showed no polyps, a low dose chest computerized tomography (CT) scan that showed no masses, and routine labs which showed a fasting glucose of 93 mg/dL. He is relatively sedentary and has a body mass index (BMI) of 24 kg/m^2. He has a history of using methamphetamines, alcohol (4-5 drinks per day since age 30), and tobacco (1 pack per day since age 18), but he joined Alcoholics Anonymous and has been in recovery, not using any of these for the past 7 years. Which of the following is indicated at this time?

A 41-year-old man presents to his primary care provider because of chest pain with activity for the past 6 months. Past medical history is significant for appendectomy at age 12 and hypertension, and diabetes mellitus type 2 that is poorly controlled. He takes metformin and lisinopril but admits that he is bad at remembering to take them everyday. His father had a heart attack at 41 and 2 stents were placed in his heart. His mother is healthy. He drinks alcohol occasionally and smokes a half of a pack of cigarettes a day. He is a sales executive and describes his work as stressful. Today, the blood pressure is 142/85 and the body mass index (BMI) is 28.5 kg/m2. A coronary angiogram shows > 75% narrowing of the left anterior descending coronary artery. Which of the following is most significant in this patient?