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This is a pleasant 61-year-old gentleman who has been experiencing dizzy on exertion. I understand that his CT scan has shown some emphysematous changes, and he was a smoker until 1992. In an effort to rule in the coronary cause of his dizziness on exertion, he underwent stress testing in October. At that time, he did do 10 ½ minutes without chest pain, ECG changes or any abnormality _____________ (sound's like) unperfused imaging. This particular function was normal.

The CT scan that was done to evaluate his lung parankima did show some very mild calcification in his ALD. I talked to radiology about that, who reviewed it again for me and said he had some very minor accumulation of calcium in his left tube and descending.

Today's exam was completely unremarkable except for him being overweight and having a blood pressure of 140/92.

IMPRESSION: At this point, given his extremely normal effort tolerance on the treadmill, absences of angina, ST segment changes or any profusion abnormalities; I think it's unlikely that there's a cardiac contribution to his dizziness. Given the calcium in his ALD, which is minor, I would encourage aggressive risk factor modification. As such, his lipid should be evaluated again if they have not been checked in awhile, and addressed accordingly.

We certainly appreciate the opportunity to participate in his care.