04 August 2021

Dr Susanne Krueger
Kowhai Surgery Ltd
P O Box 285
Warkworth
AUCKLAND

cc: Patient

Dear Susanne

Re: Mrs Christine Lawrence ─ d.o.b.: 22 April 1952

265 Omaha Drive, RD 6, Warkworth 0986
Telephone numbers: 09 422 9834 027 546 6243
NHI: LVA6633

Relevant issues:
1. Recurrent palpitations and atypical chest discomfort:
a. Coronary angiogram 03/08/21: No significant obstructive disease. Up to
50% mid-RCA stenosis and 55% mid-circumflex stenosis. Diffuse calcification
RCA and LAD
b. ETT 23/7/2021: Bruce protocol 9: 43 minutes. Limited by fatigue and chest
pressure. Diagnostic heart rate achieved. Normal blood pressure on a
borderline baseline (40/80 at rest, 200/75 late in recovery, 140/80 at five
minutes recovery). 1 - 2 mm horizontal inferior ST depression at peak exercise
c. Echocardiogram 22/7/2021: Normal LV size and function. Mild diastolic
dysfunction. Top normal LA size. No significant valvular abnormalities
2. Symptomatic but likely benign ventricular ectopy:
a. Holter monitor confirming monomorphic ventricular ectopy at 7.1% – 2018
b. Coronary angiogram Mercy 1/3/2012: Mild diffuse atheroma up to 50% in
proximal right PDA. EF 85%. LV pressure 130/17
3. Longstanding treated hypertension under good control
4. Treated dyslipidaemia
5. Family history of coronary disease - mother in her 60s
6. Surgeries including appendicectomy, cholecystectomy, oophorectomy in the distant
pass

Medications:
1. Atorvastatin 60 mg
2. Valacyclovir 500 mg once daily
3. Cilazapril 5 mg
4. Felodipine 2.5 mg
5. Citalopram 20 mg daily
6. Nitrolingual spray (new 23/7/2021)
7. Aspirin 100 mg daily (new 23/7/2021)

Allergy to sticking plaster

Christine underwent an uneventful coronary angiogram today. We did have some

challenges with access. I was unable to pass a wire through the right radial and the pulse
is quite weak on that side. The left radial was still somewhat challenging to locate but
provided good access ultimately. Interestingly there was some spasm around the sheath
when she had it removed at the end of the procedure and I wonder if spasm was occurring
while I was attempting to gain access.

There has been only moderate coronary disease with no obstructive lesions seen.

I think she should continue on her current medications for now. I would potentially
increase her Atorvastatin to 80 mg daily though I do not think that is a major issue. She
tells me that her palpitations seem to have settled and she feels reasonably well so at this
stage I will not change her other medicines. If she does have problems with palpitations my
temptation would be to change her Felodipine to Diltiazem for example or even perhaps
Verapamil. Her blood pressure during the case today was in the low normal range but she
was quite relaxed with the sedation.

I will plan to see her in follow-up in about a month but please contact me sooner if there are
questions or issues.

Yours sincere
Digitally approved by author for dispatch
Tony Scott
Cardiologist