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North York Diagnostic & Cardiac Centre

250 Marlee Avenue, North York, Ontario M6B 3H7


Tel: 416-783-0000 Fax: 416-783-0002

Ref. Physician: Dr. Gus Meglis Case No. : MU6619


Name : DIRLEA, Mihai Mircea Health Card : 8306 883 920 VP
Date of Birth : 11 September 1956 Date of Exam : 03 May 2015

CONSULTATION NOTE

Dear Dr. Meglis,

Thanks for this kind referral for evaluating Mr. Dirlea from a cardiac perspective for
symptoms of left upper quadrant and chest discomfort and history of smoking.

He has coronary artery disease risk factors:

This gentleman is 58-year-old and denies any prior history of hypertension, diabetes
mellitus, or dyslipidemia.

He is an ex-smoker and quit smoking in 1993. He has a long history of smoking prior to
that.

Allergies: None.

Surgical history: He has hernia repaired.

Mr. Dirlea describes symptoms that are not suggestive of cardiac origin. He describes
left upper quadrant abdominal discomforts that are exacerbated during ingestion of
food. He denies any history of angina. He denies any history of heart failure
symptoms. He denies any history of syncope or presyncope. Other systemic review
was unremarkable.

On examination, his blood pressure from his right arm was 110/70 mmHg. His pulse
was 70 beats per minute and regular. Cardiovascular examination revealed first and
seconds heart sounds were normal. Lungs were clear. Abdomen was soft and lax.
Peripheral pulses were palpable, equal and symmetrical.

Cardiac Investigation: Mr. Dirlea underwent an exercise stress test. He was able to
exercise for 8 minutes and 38 seconds achieving maximum METs of 10.2. He was able
to exercise for 8 minutes and 58 seconds achieving target heart rate. The stress test
was symptomatically positive and electrically positive.
North York Diagnostic & Cardiac Centre
250 Marlee Avenue, North York, Ontario M6B 3H7
Tel: 416-783-0000 Fax: 416-783-0002

Ref. Physician: Dr. Gus Meglis Case No. : MU6619


Name : DIRLEA, Mihai Mircea Health Card : 8306 883 920 VP
Date of Birth : 11 September 1956 Date of Exam : 03 May 2015

CONCLUSION:

Mr. Dirlea is a 58-year-old gentleman with history of smoking presents with atypical
symptoms. Stress test was significantly positive.

I was counseling Mr. Dirlea about the result test and how we should proceed whether
with noninvasive testing versus invasive testing.

Mr. Dirlea mentioned to me that he is going through stressful condition and has a
significant disagreement with his wife. For that, he elected to leave the clinic against
medical advice and refused any projections for followup. I did stress Mr. Dirlea that I
need to assess him further and keep close followup and continue with his medical care.
Mr. Dirlea decided to leave the clinic with no further followup or workup. I mentioned to
Mr. Dirlea that I respect his decision.

Thanks for this kind referral.

Sincerely,

DR. AYMAN AL-SALEH, MD, DABIM, FRCPC


Cardiologist
Dictated but not read: AAS

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