Depression and CAD
A 54-year-old woman presents to the office for a follow-up visit 6 months after an inferior ST-segment elevation myocardial infarction (MI). She underwent timely revascularization of the right coronary artery with a drug-eluting stent at the time of her MI and has had normal right and left ventricular function. Post MI, the patient underwent cardiac rehabilitation. Since the MI, she has had intermittent episodes of chest discomfort that are unrelated to exertion and not relieved by nitroglycerin. She had a stress echocardiogram 2 months ago that was normal. She denies any episodes of shortness of breath on exertion, palpitations, or pedal edema. The patient reports that for the past 6 months, she has been feeling very fatigued and has significant difficulty sleeping at night. She spends a lot of her time worrying about her health and that she might die of another heart attack. She has not returned back to her job as a school teacher and has lost interest in activities that she previously enjoyed like reading and hiking. On examination, the patient's temperature is 98.2 degrees F, heart rate is 86 bpm, and blood pressure is 128/74 mmHg. She is saturating 98% on room air, and her physical examination is unremarkable. The patient is currently on aspirin 81 mg daily, clopidogrel 75 mg daily, metoprolol 25 mg twice daily, and rosuvastatin 40 mg daily. She has been compliant with all her medications.
Which of the following interventions is recommended at this time?