Cardiology - Report 9

Cardiology

TAPE 8A, Report 9

CONSULTATION

The patient is a very pleasant 58-year-old white male.  He is an extremely hyper type A personality who spends a great deal of time with his work.  Basically, this patient has had hypertension for 30 years.  He has been on just about every medication that has ever come out, with variable results in management of his hypertension.

He is on Minipress 5 mg t.i.d., Catapres 1 mg b.i.d., Lopressor 100 mg t.i.d., Lasix 40 mg a day, KCl 10% two tablespoons b.i.d., Nitro-Bid ointment 2-1/2 inches b.i.d.  He is also on a 4-g sodium diet.

On physical examination, the patient’s pulse is 50 and regular and is in sinus bradycardia.  Blood pressure 138/70 standing and 140/70 lying.  The fundi show very minimal AV nicking in each eye.  There is a bruit noted in the right carotid area.  There is an S4 noted.  There is a very faint systolic ejection murmur along the left sternal border.

The ECG performed here in the office today shows sinus bradycardia at a rate of 50 beats per minute.  There are the changes consistent with the old inferior infarction.  There is no evidence of an anterior infarction other than some reduction of the R waves across the precordium.

IMPRESSION

1. Status post acute inferior wall infarction with residual sinus bradycardia and associated symptoms of weakness and fatigue.  This patient may need a pacemaker.

2. Long-term chronic hypertension which, on the current medication, is well controlled at this point in time.

RECOMMENDATIONS

1. We will do a PA and lateral chest x-ray and repeat the laboratory values.

2. We will perform a resting nuclear ventricular function study to assess his ejection fraction and wall motion.

3. Next week we will perform a submaximal treadmill stress test, and based on this study we can plan his rehabilitation program.  In 8 weeks we will do the full-blown treadmill stress test, and based on that we will make the final modifications of his exercise program.

We will today perform a Holter monitor to determine just how much a problem his sinus bradycardia is, and if there are further drops in his rate into the 40s with symptoms, I would then, at that point in time, consider atrial pacing studies and whether or not there may be a need for a permanent atrial pacemaker.

FOOTNOTE

Line 15 (Page 1).  When the physician dictates a drug that has both a generic and trade name (i.e., KC1 and Kayciel), select the generic if the physician’s preference is not known.

Line 20 (Page 1).  The abbreviation BP was expanded to blood pressure.

Line 21 (Page 1).  AV (arteriovenous) nicking, not atrioventricular.