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From: Denzel W. Pollock, M.D., F.A.C.C Consultative Cardiology


RE:  Stephen xxxx

Dear Gregory,

Thanks for referring Mr. xxxx for evaluation.  The patient is referred over with mild chest discomfort and an interventricular conduction delay on his EKG.  The patient does not have known cardiac disease, but does have a history of Lymes disease ( I don’t have blood tests available on him, so I don’t know what status he is at), but he has had symptoms probably going back to 1990 and apparently was diagnosed with Lymes at that time and had neurologic symptoms related. He has been undergoing his current treatment since July 30th of this year and even at a relatively short period of time (actual treatment about 30 days so far) he is feeling better. He states that he has had a decrease of pain generally over all.  He can lift his arms somewhat further. He can stand up on his own and he has started physical therapy. This is remarkable since he has given diagnosis of ALS going back about 7 years.

The chest pain that got him sent over here is relatively mild. There has been a distinct improvement since he has been on antibiotic therapy. It is not accompanied with dyspnea. It is not particularly exertional in nature and is atypical in quality.

His past history is negative for typical angina, MI, CHF, CVA, murmurs, cardiomegaly, cardiac arrest and the like. He does not have a history of diabetes or hyperlipidemia or hypertension. In fact, he tends to run on the low side.

His general history is negative for known thyroid or pulmonary disease, hepatic or renal disorders, bowel disorders, anemia, bleeding, et cetera. No history of cancers. He has been diagnosed with only Lymes disease, but also of Babesia as per his recollection.

His medications include Zithromax, Viramycin, and Mepron. He’s been getting Rocephin 2 injections per week. He may have had an allergic reaction in 1992, but he is quite unsure what he is allergic to.

The patient is married and lives with his wife. He does not drink. He quit smoking 5 years ago. His activity of necessity has been limited recently.


His father is 77 and in good health. He has had two uncles who had MI’s. His father had a MI at age 75, but is recovering well. His mother is 74 and has fibermyalgia. There is a family history of cancer, heart disease and stroke.

His system review reveals no recent fevers, chills or the like, although they have certainly been present in the past. He has some blurring of vision and wears glasses. He has had some problems with sore throats and some swelling in the neck. All of these have improved recently. He has not had typical chest pain, shortness of breath, PND, orthopnea, palpitations, syncope, pedal edema or the like. He has noted some change of bowel habits and has a history of constipation. He has noted no GI bleeding. He has history of joint pain, muscle stiffness and weakness and, of course, difficulty walking. These are improved, although he has quite a ways to go on the neurologic front.

His blood pressure measures 82/48 and he is surprisingly tolerant of this. His pulse is 70 and regular. His weight appears to be 112, although he had some difficulty balancing on the scales. He is alert, oriented in no acute distress. His color appears appropriate. Sclera anicteric. Mucous memebranes moist. His neck is supple without JVD or bruits. Carotid upstrokes are intact and 2+. Chest is clear to auscultation and percussion to the bases. The back is non-tender. The heart is regular in rate and rhythm. S1 and S2 are physiologic. No S3, S4, gallops or rubs. The PMI is not displaced. The abdomen is soft, non-tender, no organomegaly. Normal active bowel sounds. No bruits. His extremities have intact pulses and are without edema. His EKG shows sinus rhythm and a mild interventricular conduction delay.

I cannot entirely rule out a Lymes carditis as the cause of the interventricular conduction delay. It does not appear to have changed greatly. It certainly could be related to other factors as well. Importantly, I don’t see any evidence of high grade A V block. Severe bradycardia or the like. Neither do I see any evidence of cardiomyopathy. His cardiovascular status appears to be stable and I think the chest pain is probably not coronary as there has been a dramatic improvement since starting Lyme therapy. I suspect it is thus musculoskeletal in relation.

In any case, I think his appropriate approach is to continue the Lymes therapy and to hope for continued neurologic improvement. I don’t think we need to do anything specifically cardiac at the moment, however I do remain available with future questions or concerns.
 
Thank you,


Denzel W. Pollock, M.D., F.A.C.C