RE: Cardiology Referral for Michael Chen (MRN: 456789)

I am referring Mr. Michael Chen, a 57-year-old male with a twelve-year history of hypertension for cardiology evaluation due to recent concerns about worsening blood pressure control and new onset exertional chest discomfort. His blood pressure has been suboptimally controlled over the last three months despite medication adjustments, with readings consistently 145-155/90-95 mmHg. During his most recent visit on April 15, 2025, he described intermittent chest pressure that occurs primarily with moderate activity and resolves with rest, a new symptom that has been increasing in frequency over the past two months.

Mr. Chen's cardiovascular risk factors include his long-standing hypertension, hyperlipidemia (LDL consistently 130-140 mg/dL despite statin therapy), family history of premature coronary artery disease (father with MI at age 59), and former tobacco use (quit 8 years ago, 20 pack-year history). His most recent electrocardiogram on April 15, 2025 showed nonspecific T-wave inversions in leads V4-V6 that were not present on his previous ECG from October 2024. His most recent lipid panel from March 2025 showed Total Cholesterol: 212 mg/dL, LDL: 138 mg/dL, HDL: 42 mg/dL, and Triglycerides: 160 mg/dL. Other relevant labs include normal renal function (GFR > 60 mL/min) and a fasting blood glucose of 108 mg/dL.

His current medication regimen includes Lisinopril 40mg daily (increased from 20mg in February 2025), Amlodipine 10mg daily, Atorvastatin 40mg daily, and low-dose Aspirin 81mg daily. He reports good medication adherence, which is supported by his pharmacy refill history. I would greatly appreciate your evaluation for possible coronary artery disease and recommendations for further diagnostic testing and management. Given his risk factors, new symptoms, and ECG changes, I am concerned about possible ischemic heart disease requiring more aggressive intervention. Please let me know if you need any additional information. Thank you for seeing this patient.

Sincerely,
Dr. Sarah Reynolds
Internal Medicine
Contact: (555) 123-4567