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    1. Coronary artery disease predominately involving proximal portion of left anterior descending. More than 70% stenosis is noted in the area of significant calcified plaque formation.

    RECOMMENDATION: Further evaluation with catheter angiogram with possible stent placement is recommended.

    PATIENT RISK FACTORS: High blood pressure and atrial fibrillation. Patient is likely overweight.

    INDICATIONS: Recent stress EKG was within normal limits. However, patient has hypertension and shortness of breath.

    CONSENT: Written informed consent was obtained prior to the examination from the patient after risks and benefits of the procedure were explained.

    TECHNIQUE: This imaging study was performed on a 64 slice Toshiba Aquilion MD CT scanner using EKG gated prospected triggering. Volumetric acquisition was made from the level of the carina to the base of the left ventricle. Volumetric reconstructed and curved planar reformatted images were reconstructed. Vessel analysis was performed at the Vitrea workstation. 5.0 ml of Metoprolol was given intravenously right before the examination. Heart rate during the scan was regular. 85 cc of Isovue 370 non-ionic intravenous contrast was given at 5 cc per second with 18 gauge Angiocath needle. Bolus chase of 40 cc of saline was also given at 5.0 cc per second.


    Coronary CT Angiography: The anatomy of the coronary arteries are normal. Right sided dominance is demonstrated.

    Left Main: There is no evidence of significant calcified or non-calcified coronary plaque formation.

    Left Anterior Descending: Significant atherosclerotic calcifications are demonstrated in the proximal portion and proximal portion of first diagonal branch. More than 70% of focal stenosis is noted at the proximal portion in the region of the significant calcified plaque formation.

    Left Circumflex: Several and minimal calcified plaque formations are demonstrated with no significant focal area of stenosis.

    Right Coronary Artery: Calcified plaque formations are demonstrated at multiple areas. However, there is no focal area of significant stenosis nor obstruction.

    Other Findings: No abnormal filling defects are noted in the pulmonary vasculature. The aorta is normal in caliber and contour. Visualized lung fields demonstrate no suspicious nodule nor infiltrates.

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    Can I bill for the EKG, Metoprolol, and Nitrostat?

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