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Just Say No To Teratogens

Mailbag

Neda Frayha, MD and Paul Simmons, MD
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No me gusta!

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Ian L., Dr -

For a patient with a calculated high risk of a coronary event within five years defined as the range 3%-6% a year for 5 years wishing to do a gym programme which is rarely “moderate “ exercise I would want a patients to have a stress heart test and if over 50 a anatomical view of the coronary vessels by MRI or low radiation dose computed coronary angiogram .
At the the minimum you are obligated to discuss this with your patient before signing the ok to go to gym form .
So I agree with Dr Simmons a diabetic male aged 60 diabetics of 10 years duration who has smoked for thirty years one 20 packet per day of cigarettes would never be given permission for a private gym programme without comprehensive cardio logical evaluation .

Ian L., Dr -

Further to this the Duke Calculator which measures type of pain and risk factors recommends ecg stress test (could be any type )for male and female 60 year old diabetics who smoke .
Based on CCTA one artery showing 70% stenosis .
Flow of blood through the stenosis can be measured on exercise .
Ought help safety of gym exercise programme I believe .

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Primary Care RAP November 2019 Written Summary 1 MB - PDF

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