Prepared for doctor review

Thiago Madeira Pinto

Comprehensive medical history through June 2026, combining clinical conclusions, longitudinal lab data, source reports, and raw tables from the Health archive.

Open source archive
DOB
08/10/1986
Contact
+353 83 421 0235
Email
madpin@gmail.com
Address
7 Bank House, Cornmarket, Christchurch, Dublin 8, D08DX28
GP
Dr Nada Yasir, Dame Medical Centre
TUH MRN
1300993
Cardiology
Dr Breda Hennessey, Blackrock Private Clinic
Rheumatology
Prof Richard Conway, Blackrock Private Clinic

Current clinical picture

Doctor Brief

Established coronary artery disease

Moderate multi-vessel CAD with coronary ectasia, calcium score 1207.2 AU (99th percentile), and documented transmural inferior wall MI. LV systolic function preserved, EF around 65-66%.

Inflammatory arthritis / autoimmune overlap

Relapsing flares since June 2025 with tenosynovitis, effusions, enthesitis, dactylitis symptoms, heat/stress triggers, and seronegative profile. June 2026 CRP and ESR show no biochemical inflammatory activity.

June 2026 metabolic and biochemical flags

HbA1c 50 mmol/mol (~6.7%), ferritin 618.4 µg/L with normal transferrin saturation, calcium 2.64 mmol/L and adjusted calcium 2.57 mmol/L with normal PTH, triglycerides 1.80 mmol/L, bilirubin 28 µmol/L, ALT 56 IU/L, GGT 81 IU/L.

Repleted nutrition markers

Vitamin D 139 nmol/L, B12 511 ng/L, serum iron 24 µmol/L, transferrin saturation 38%, total protein 76 g/L, and PTH 2.5 pmol/L on 28 June 2026.

Medication reconciliation items to verify

Source documents conflict on two doses: ezetimibe appears as 20 mg in summary sections and 10 mg in the current medication list; bimekizumab appears as monthly in the therapy section and weekly in the medication list.

Latest flagged laboratory values

Extracted from the 28 June 2026 blood report source tables.

Diagnosis / medical condition register

Medical Conditions

1

Coronary artery disease

Established CAD + prior MI

Moderate multi-vessel coronary artery disease with extensive atherosclerotic burden, coronary ectasia, and established transmural inferior wall myocardial infarction. Left ventricular systolic function is preserved.

Key evidence

  • Coronary calcium / Agatston score 1207.2 AU, 99th percentile for age and gender.
  • MRI scintigraphy documented transmural inferior wall myocardial infarction.
  • July 2024 angiogram: LAD distal 50% stenosis with proximal/mid ectasia; first diagonal 50% ostial stenosis; LCX mild OM1 disease 20-30%; RCA distal 50% stenosis with moderate ostial disease and ectasia.
  • RCA instantaneous flow reserve 0.99, non-flow limiting despite anatomical stenosis.

Function and risk context

  • EF 66%; echo valves normal, preserved diastolic function, no pericardial effusion, no pulmonary hypertension.
  • Stress testing negative for exercise-induced ischaemia with good haemodynamic response.
  • 24-hour BP average 125/76 mmHg with expected nocturnal dip.
  • Risk context: 18 pack-year smoking history, currently vaping; weight loss from 120 kg to 90 kg; strong family history of MI and dyslipidaemia.

June 2026 lipids

  • Total cholesterol 2.83 mmol/L; LDL 0.94 mmol/L; HDL 1.06 mmol/L; non-HDL 1.77 mmol/L.
  • Triglycerides 1.80 mmol/L, mildly elevated.
  • ApoB 0.67 g/L; ApoA-I 1.28 g/L; ApoB/A-I ratio 0.52.

Current management in source

  • Aspirin 75 mg daily.
  • Rosuvastatin 40 mg daily; ezetimibe listed in the source summary as 20 mg daily.
  • Ramipril 10 mg daily; lercanidipine 20 mg daily; indapamide SR 1.5 mg daily.
  • January cardiology review and stress ECG noted no new concerns aside from BP, for which indapamide was added.

2

Inflammatory arthritis / autoimmune inflammatory disease

Possible dermatomyositis + psoriatic arthritis overlap

Onset June 2025 with near-daily, brief relapsing inflammatory flares. The pattern is atypical: rapid onset around 10 minutes, 1-4 hour duration, heat/stress triggers, and resolution faster with cold.

Clinical pattern

  • Episodic hot swollen joints: knees symmetrical L>R; hands/wrists, shoulders, and neck sometimes asymmetrical.
  • Minimal tenderness and no axial involvement reported in the source summary.
  • Associated enthesitis, recurrent right forearm tendonitis, intermittent plantar fasciitis, costochondral pain, and episodic dactylitis.
  • Heat-related non-pitting oedema of hands and feet since December 2025; mild morning stiffness.
  • Evolving picture includes worsened pain, fatigue and nausea with flares, more muscle pain/inflammation, and more persistent low-grade fevers.

Imaging and ultrasound evidence

  • Informal ultrasound by Dr Adsurada: right hand extensor tendon tenosynovitis; bilateral knee effusions in subcutaneous tissue; loss of trilaminar plate on right middle fingernail suggesting nail involvement.
  • Cervical MRI: diffuse disc dehydration; C5-C6 and C6-C7 disc bulging with dural compression but no myelopathy; foraminal cysts contacting/near nerve roots.
  • SI joint MRI normal with no inflammation or erosions.
  • Right shoulder MRI: rotator cuff tendinopathy, subacromial bursitis/impingement, and glenohumeral chondral thinning.
  • Wrists/hands and knees normal; feet/ankles show posterior calcaneal enthesophyte only.

Serology and monitoring

  • Seronegative profile: HLA-B27 absent; RF and anti-CCP negative; ANA and ENA/dsDNA markers negative; antiphospholipid tests negative.
  • Coeliac serology negative; C3 normal and C4 borderline low in December 2025.
  • June 2026: CRP <1.00 mg/L and ESR 2 mm/hr, with no biochemical inflammatory activity.
  • June 2026 RF <10.0 IU/mL, CTD screen 0.20 ratio, C3 1.330 g/L, C4 0.181 g/L, CK 119 U/L.
  • June 2026 FBC overall normal, with mildly elevated MCH 33.9 pg and MCHC 36.4 g/dL.

Current and previous therapy

  • Current: methotrexate 25 mg subcutaneous weekly, started 22 May 2026.
  • Current: Bimikizumab 160 mg subcutaneous monthly, started 27 May 2026, as written in the source summary.
  • Previous: methotrexate dose changes between 15 mg and 20 mg weekly; decrease appeared to worsen flares; previous transient neutropenia and thrombocytopenia.
  • Previous: adalimumab/Hulio escalated from every 2 weeks to weekly with minimal effect.
  • Colchicine 0.5 mg twice daily was poorly tolerated and did not convincingly help; secukinumab was started April 2026 before change to Bimikizumab.

3

?Avoidant/restrictive food intake disorder

Not formally diagnosed

The source notes that the clinical presentation meets diagnostic criteria for ARFID, but this has not been formally diagnosed and is not yet integrated into multidisciplinary care.

Dietary pattern

  • High carbohydrate, low fibre pattern.
  • Diet described as carbohydrates, cheese, and nuts, with no fruits, vegetables, or meat.

Associated consideration

  • Possible autism spectrum disorder, not formally assessed.

4

Nutritional deficiencies and metabolic findings

Repleted vitamins; active HbA1c, ferritin, calcium flags

Previous iron, vitamin D, vitamin B12, protein, and PTH issues have been treated or repleted, but the June 2026 bloods show HbA1c in the diabetic range, elevated ferritin, and elevated calcium with normal PTH.

Current micronutrient panel

  • Iron 24 µmol/L with normal transferrin saturation after IV iron replacement.
  • Ferritin 618.4 µg/L, elevated despite normal transferrin saturation.
  • Vitamin D 139 nmol/L and B12 511 ng/L after replacement.
  • Total protein 76 g/L and PTH 2.5 pmol/L on the most recent testing.

Supplementation received

  • Cosmofer IV iron.
  • Vitamin D replacement.
  • Vitamin B12 intramuscular replacement.
  • Repeat bloods completed 28 June 2026.

Glucose metabolism

  • Prior fasting glucose 6.2 mmol/L, elevated above source normal <5.5 mmol/L.
  • HbA1c 50 mmol/mol, approximately 6.7%, on 28 June 2026.
  • HbA1c increased from 45 mmol/mol / 6.3% in December 2025.
  • Source clinical note: likely multifactorial, including poor diet quality, weight distribution, and metabolic inflammation.

Iron and calcium/PTH

  • Serum iron 24 µmol/L; iron saturation 38%; TIBC 63 µmol/L.
  • Total calcium 2.64 mmol/L and adjusted calcium 2.57 mmol/L, elevated against source range 2.15-2.50 mmol/L.
  • PTH 2.5 pmol/L within source range 1.6-6.9 pmol/L; phosphate 1.13 mmol/L normal.

5

Gilbert's syndrome

Intermittent jaundice and bilirubin elevation

Pattern

  • Elevated total and direct bilirubin with intermittent episodes of jaundice.

June 2026 bloods

  • Total bilirubin 28 µmol/L.
  • Mild ALT elevation 56 IU/L and GGT elevation 81 IU/L.
  • AST, ALP, albumin, and total protein normal in the source summary.

6

Attention-deficit/hyperactivity disorder

Formally diagnosed

Diagnosis and constraint

  • Formally diagnosed at ADHD Doc.
  • Stimulant medications contraindicated due to cardiac history and cardiologist concern.

Current management

  • Atomoxetine initiated.

7

Androgenetic alopecia

Maintenance treatment

Current management

  • Maintained on finasteride 1 mg daily.

8

Structural, urological, and reproductive conditions

Multiple structural findings; no Irish specialist follow-up noted

Left inguinal hernia

  • Incidental ultrasound finding in January 2024.
  • 2.2 cm protrusion of abdominal contents.
  • No intervention to date; not yet linked with Irish specialist for management planning.

Left varicocoele

  • Identified on scrotal ultrasound in January 2024.
  • Associated with abnormal semen parameters.
  • No intervention to date; no specialist follow-up arranged in Ireland.

Prostatomegaly

  • Mild prostatomegaly on ultrasound, approximately 30 g.
  • PSA 0.37-0.44 µg/L, normal; most recent source note says November 2025.
  • Family history: father had prostate cancer despite normal PSA.

Erectile dysfunction

  • Good response to tadalafil 5 mg daily.

Semen analysis, March 2024

  • Total sperm concentration 0.30 × 10⁶/mL, low against normal >15 × 10⁶/mL.
  • Total sperm count 0.6 × 10⁶ sperm, low.
  • Overall motility 25%, low against normal >40%.
  • Source interpretation: severe oligozoospermia with reduced motility, likely secondary to varicocoele.

Visual summary

Diagrams

Cardiovascular Map

Coronary artery disease map showing calcium score and angiography findings Agatston score 1207.2 99th percentile Function EF 66% Preserved LV systolic function Inferior wall transmural MI on MRI LAD distal 50% RCA distal 50%, IFR 0.99

Inflammatory Disease Pattern

Inflammatory disease pattern and investigations Relapsing flares heat/stress triggered Joints knees, hands, wrists Tendons tenosynovitis, bursitis Serology seronegative profile Current therapy MTX + bimekizumab

Unit Provenance

Unit provenance diagram for mixed regional laboratory units Brazil sources mg/dL, /mm³ local references Ireland/SI mmol/L, µmol/L 10⁹/L, g/L Other source units preserved as written with source ranges Canonical longitudinal tables Converted only where source notes explicitly say so

Chronology

Medical Timeline

Current list from main source

Medication

Longitudinal graphs

Lab Trends

Graphs use the canonical longitudinal tables in the June 2026 medical history file, then display values in the selected Irish, Brazilian, or South African unit profile.

Extracted from all Markdown files

Raw Tables

Full Health archive

Source Documents

Selected source

Select a source document

Safety notes

Units and Source Integrity

Canonical comparison

The June 2026 longitudinal tables remain the underlying comparison source. The visible site converts recognized measurements into the selected country unit profile without changing the source files.

Raw source values

Brazilian reports commonly use mg/dL and /mm³. Irish reports commonly use mmol/L, µmol/L, 10⁹/L, g/L, and IFCC HbA1c mmol/mol. South African display uses SI-style chemistry units with local defaults configured in the unit switcher.

Clinical verification

This is a patient-prepared website. Clinical decisions should use the original reports. Values without an explicit unit in the raw source are left as written rather than guessed.