CARDIOLOGY DISCHARGE SUMMARY

FINAL DIAGNOSES

1. Bilateral pneumonia.

2. Congestive heart failure.

Three.

3. Cardiomyopathy, cause unknown, rule out underlying coronary

insufficiency.

4. Hypertension.

5. Diabetes mellitus.

SUMMARY

Tthis patient is a 77-year-old white female who is has been feeling ill for two 2
weeks. Tthe patient states that she has copper cough with carina greenish sputum
production. She feels short of breath. She was nauseated after bouts of
coffeecough. She also feels pain in the lower rib area on the left side which started
after a bout of severe cough. The patient was seen in the emergency room. Initially
chest x-ray and chemistry showed presence of heart failure. Iit was highly
suggestive of pulmonary edema. The patient is has underlying cardiomyopathy.
The patient had seen me two 2 years ago which but she has is failed built to keep
follow-upsfollowup in the office and is has not been fully evaluated for the cause
or of her cardiomyopathy. Tthe patient has been followed by her family physician
Dr. BlankDr *****, and is taking a small dose of Lasix.

The patient is bringing up a large amount of greenish yellow sputum. She denies
any fever. just She has left left-sided pain. sShe sleeps in a chair and is has notice
noted swelling in her feet in the last one 1 week.
PAST MEDICAL HISTORY

as As outlined above. She also has hypertension and a past history of pneumonia.

PHYSICAL EXAMINATION

Tthe patient appeared acutely ill. She was in the intensive care unit. Her for
temperature was 97.6, respirations 16. Unto On 2 L, leaders for her oxygen
saturation is was 98%. Initially she waits weighed 61 kg. Ffinal weight is was 57
kg. Heart sounds are were distant. Lungs: dDiminished breath sounds with crackles
at the baseis. Her femoral pulses or were 4+, dorsalis pedis pulses were 4+, and
posterior tibia tibial pulses are were negative.

SIGNIFICANT LABORATORY DATA

her Her chest x-ray on July 9, 2006, shows findings are representing congestive
heart failure. On July 11, 2006, findings showing stable congestive heart failure,
left lower lobe atelectasis or pneumonia. Echocardiogram with a Doppler shows
segmental wall motion animality abnormality was with severely impaired systolic
function of the left ventricle and ejection fraction of 21%. Traced mitral
regurgitation and trace aortic regurgitation were are present. A In comparison of to
previous study on September 6, 2005, there's there is further deterioration in left
ventricular systolic function with rejection reduction and in ejection fraction from
35% to 21%. Repeat x-ray on July 12, 2006, shows decreased pulmonary edema;
on of July 14, 2006, showsed cardio medleycardiomegaly, bilateral pleural
effusions, by Basler bibasilar consolidation, and compressive atelectasis.

On the day of discharge, of the UN her BUN is 33, creatinine 1.3, glucose 70, and
sodium 136. Platelets at are 357,000. Bblood cultures of have no growth after five
5 days. BNP on July 15, 2006, was is 515; it. It is coming down. Platelet count is
normal. BNP on July 13, 2006, 0702 702. Iinitially the patient had hyponatremia.
Sputum culture had formal normal respiratory flora. Initially your her sodium level
was 132, potassium 5.4, B1 BUN 17, creatinine 1.0, and glucose 120. Cardiac
enzymes were are negative for myocardial necrosis. Initially hemoglobin 11.5,
white Y count 11.3. BNP on admission was 2418. Bblood gases ship showed pH
7.3, PCO2 of 37, NPO PO2 of 266. On room air, her oxygen saturation is 93.2%.
On admission, white count was 15,100.

HOSPITAL COURSE

The patient was in the intensive care unit. She was off on she was on oxygen
supplementation. Sshe was given Lasix. The jocks andDigoxin, ace ACE
inhibitors, and beta blockers were all administered. She was treated for pneumonia
without with Avelox. locks. She was bringing up greenish sputum; it e. Eventually
cleared up. The patient had frequent episodes of cough. She still thought that she
had cracked a few ribs on the left side. She wanted Percocet. I did not give her
Percocet. The pPatient was explained the nature of her disease, including
cardiomyopathy and the need for further workup such as cardiac Thursday
showedcatheterization.

The patient agreed to follow-up follow up in the office in this regard. She would be
discharged today to see me in two 2 weeks. Low-salt low-salt diet and escape 64
ounces for ounce fluid restriction per for 24 hours. We will checked her oxygen
level on room air. If her oxygen level is less than 90%, she will require oxygen
supplementation at home.

ON MEDICATIONS

1. Spironolactone Spore lactone 25 mg daily.

2. I will locks Avelox 400 mg daily for five 5 more days.

3. Lisinopril 10 mg PIDb.i.d..

4. Memphis Lantus insulin 40 units at bedtime.

5. Vicodin bike five 5/500 number #60, one PRN p.r.n. q.4 h. Q4 hours for
pain.

6. Toprol-XL 100 mg one 1 daily.

7. Furosemide 40 mg twice a day.

8. Digitek 0.125 mg daily

DISCHARGE INSTRUCTIONS

A 64 64-ounce fluid restriction. Low-salt diet. Follow-up Followup in two 2 weeks

in the office. Get a repeat chest x-ray before seeing me.