NORTH YORK DIAGNOSTIC & CARDIAC CENTRE

1017 Wilson Avenue, Suite 100 North York, ON M3K 1Z1

Tel (416) 631 7581 II Fax (416) 631 9759

Ref. Physician: Dr. S. Goldberg File No. : NY11071

Name: D'AGNONE, Robert An Health Card :
Date of Birth: 06 February 1948 Date of Exam: 01 April 2015

STRESS TEST AND CONSULTATION NOTE

Dear Dr. Goldberg,

Many thanks for referring Mr. D’Agnone for cardiovascular assessment. This 45-year-
old Systems Administrator is married and has two children.

His medical history is significant for diabetes diagnosed 15 years ago. He has been
treated with insulin. He is followed by Dr. Goldenberg. He also has congenital
dyserythropoiesis with anemia. He is followed by Dr. Richard Ward at Toronto General
Hospital. He has also developed arthritis in his knees and ankles. There is no history
of coronary disease, stroke, renal insufficiency or bleeding.

His medications include vitamin D, Naproxen, Insulin and an iron chelator. He has no
known drug allergies. He quit smoking 15 years ago. He rarely consumes alcohol.
There is no family history of coronary disease.

Mr. D’Agnone leads a rather sedentary life. In the summer, he would occasionally bike
with his daughter but over the winter, he has minimal exercise. He remains
asymptomatic. Specifically, he denies any symptoms of chest pain, tightness or
pressure, shortness of breath, presyncope, syncope or palpitations.

On examination, his heart rate was 80 beats per minute and regular and blood pressure
was 140/70 mmHg. Heart sounds were normal. Chest was clear. There was no
peripheral edema.

He underwent an exercise treadmill stress test today. On the Bruce protocol, he

exercised for 6 minutes achieving a maximum heart rate of 169 beats per minute, which
is 97% of his age-predicted maximum heart rate. His blood pressure at rest was
110/70, which increased to 160/70 at peak stress. Baseline electrocardiogram showed
normal sinus rhythm. With exercise, there were no ST segment changes significant for
ischemia. He had no chest pain or tightness. Overall, this was a symptom and ECG
negative stress test with below average exercise tolerance.

An echocardiogram showed mild concentric left ventricular hypertrophy. There was no

significant valvular abnormality. There was normal left and right ventricular systolic
function.
 NORTH YORK DIAGNOSTIC & CARDIAC CENTRE
1017 Wilson Avenue, Suite 100 North York, ON M3K 1Z1
Tel (416) 631 7581 II Fax (416) 631 9759
Mr. D’Agnone is a young 45-year-old gentleman who has longstanding diabetes treated
with insulin. He is certainly at risk for future cardiovascular events. At the current time,
he is asymptomatic with no obvious signs for obstructive coronary disease. He requires
no further cardiac testing, however, does require continued aggressive risk factor
modification. He is overweight. I discussed this with him today. I have asked him to
increase his activities during the summer to lose weight. He also needs to modify his
diet. I see that he is not on a statin medication despite his diabetes. He informs me
that Dr. Goldenberg keeps a close eye on his lipid status and told him that his values
were extraordinary and therefore a statin was not used. I have asked him to follow up
with Dr. Goldenberg in regards to his diabetes management. He was unaware of his
hemoglobin A1C today. I did not initiate any new medical therapy. He will follow up with
yourself for regular monitoring of his blood pressure.

Sincerely,

DR. AKSHAY BAGAI, MD, FRCPC

Cardiologist
Dictated but not read: AB