Basinger Abraham - Consultation

CONSULTATION
SPRINGFIELD REGIONAL MEDICAL CENTER

100 MEDICAL CENTER DRIVE SPRINGFIELD, OH 45504
CONSULTATION
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MED REC NO: ******* ROOM: 3002
ACCOUNT NO: ******* ADMIT DATE: **/**/****
PROVIDER: Abram Basinger
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INDICATION: Anticoagulation.
HISTORY OF PRESENT ILLNESS: The patient is a 72-year-old female, who presented to
the hospital for sepsis, metabolic encephalopathy with UTIs, has been started on IV
antibiotics. The patient appears to be back to baseline, also found to have left
lower extremity DVT as well and started on Xarelto and started on Eliquis. The
patient has a history of CVAs and is already on Plavix and aspirin. She was
consulted by hospitalist, who determined why anticoagulation is necessary. The
patient has been having episodes of epistaxis on 3 anticoagulants. The patient had
an echo done on this admission. Echo showed left ventricular systolic pressure was
normal, EF of 50%, grade 2 diastolic function, moderately dilated right heart, mild
AS, mean gradient had 10 mmHg, mild tricuspid regurgitation. RVSP was 64 mmHg. No
pericardial effusion.
PAST MEDICAL HISTORY: She has a history of anemia; anxiety; rule out spasms; CAD;
CHF; chronic kidney disease; end-stage renal disease, on dialysis; diabetes;
emphysema; epilepsy; GERD; hypertension; hyperlipidemia; hypothyroid; paraplegic;
schizophrenia; SVT; and UTIs in the past.
PAST SURGICAL HISTORY: Appendectomy, AV fistula, heart cath in 2013,
cholecystectomy, colonoscopy, hernia repair, and thoracentesis.
FAMILY HISTORY: Mother and father both died from heart disease.
ALLERGIES: She has allergies to CELEBREX, BACLOFEN, GABAPENTIN, and NITROGLYCERIN.
HOME MEDICATIONS: Allopurinol, Percocet, Zoloft, Keppra, Maalox, amiodarone,
aspirin, Lantus, lactulose, Renvela, Protonix, Plavix, _____, Synthroid, and _____.
REVIEW OF SYSTEMS: A 10-point review of systems is negative unless noted otherwise
in HPI.
PHYSICAL EXAMINATION:
GENERAL: The patient is awake and alert, some confusion noted. She was able to
tell me location. Not in any acute distress.
VITAL SIGNS: Afebrile at 97.9. Pulse is at 62, normal sinus rhythm. Blood
pressure 107/44. She was satting 100%.
HEENT: Head is normocephalic, atraumatic. Pupils are equal and reactive to light.
No acute epistaxis noted during the examination.
CHEST: Equal and expansive.
LUNGS: No wheezes or rhonchi. Crackles noted.
HEART: Rate and rhythm regular. No clicks, gallops, or murmurs noted.
ABDOMEN: Soft, nontender. Bowel sounds are present in all four quadrants. No
hepatosplenomegaly or guarding noted.
EXTREMITIES: No clubbing or cyanosis. Nonpitting lower extremity edema.
NEUROLOGICAL: Cranial nerves II through XII are grossly intact.
LABORATORY DATA: Creatinine 4.5, potassium 5.2. Troponin 0.06. Hemoglobin at
10.5.
IMPRESSION: The patient is a 72-year-old female, paraplegic, who presented with
metabolic encephalopathy, UTI, and DVT. Started on Eliquis for DVT with dual-
antiplatelet therapy before this due to previous CVA and stent in the past. At
this time, we will stop aspirin. If nosebleeds continue, we will look at stopping
Plavix and resuming aspirin. An echo appeared stable at this time. We will
continue to monitor condition. All questions have been answered. The patient was
seen at the time of dialysis.
This plan was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 9:47:41 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22915116
CC:
CONSULTATION
CONSULTATION
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CONSULT DATE: **/**/****
INDICATION: AFib with RVR.
HISTORY OF PRESENT ILLNESS: The patient is a 77-year-old female who was diagnosed
with COVID yesterday in the nursing facility. She was on 4 liters of oxygen and
still satting in mid 80s, and was bumped up to 6 liters of oxygen, now is 90%.
Also, she is complaining of generalized weakness as well. In the emergency
department, she then went into AFib with RVR with short runs of VT, rapid response
was called, and blood pressure was dropping into the 50s and into the 80s. She was
then cardioverted there in the ED and started on amiodarone drip. She had been
moved to the floor. After moving to the floor, she went back into AFib with RVR.
Heart rate was bouncing around 100s to 160s. Amiodarone drip is on half dose at
this present time. She is satting 99% on 2 liters. Blood pressures are running
soft. She has no previous AFib history. She does have a history of CAD in the
past with a heart cath done earlier this year on **/**/****, that showed left main
was patent, LAD had mild disease, circ had mild disease, RCA had artery mid stent
was patent, and just continued with medical treatment. Last echo was on **/**/****
that showed EF 55%, mild left ventricular hypertrophy, no evidence of any
pericardial effusion, left ventricular systolic function was normal.
PAST MEDICAL HISTORY: CAD, history of hypertension, hyperlipidemia, thyroid
disease, and MRSA.
PAST SURGICAL HISTORY: Appendectomy, cholecystectomy, esophageal dilation, gastric
bypass, hernia repair, hysterectomy, left knee replacement, laparotomy of the
sigmoid, and skin lesion resection.
FAMILY HISTORY: She has no known family history of CAD or AFib.
SOCIAL HISTORY: She is a former smoker. She does admit to very little alcohol use
and no illicit drug use.
ALLERGIES: She has allergy to ASPIRIN, DARVON, DEMEROL, DILAUDID, and WELLBUTRIN.
HOME MEDICATIONS: She is on lisinopril, Ranexa, Crestor, Lasix, vitamin B12,
midodrine 10 mg, Carafate, Protonix, _____, Tapazole, _____, turmeric, metoprolol,
Plavix, prednisone, and Celexa.
REVIEW OF SYSTEMS: Not able to be assessed, the patient is not answering questions
appropriately.
GENERAL: The patient is lethargic, nodding for responses, ill appearing.
VITAL SIGNS: The patient is afebrile at 98.9, respirations are at 19, pulse is at
142, blood pressure 104/76. She is satting 99% on _____ liters.
LUNGS: Crackles in bases. No wheezes or rhonchi noted.
HEART: Rate and rhythm irregular, accelerated heart rate and rhythm.
EXTREMITIES: No cyanosis or clubbing noted.
NEUROLOGIC: Cranial nerves II through XII are grossly intact.
LABORATORY DATA: Potassium is at 4.5, creatinine is at 0.8. Lactic acid elevated
at 2.9, that is down, was previously 4.0. Troponin 0.015. ProBNP 5383.
Hemoglobin is at 10.6, white blood cell count at 9.7. D-dimer is 343.
DIAGNOSTIC STUDIES: Chest x-ray showed small right pleural effusion, scarring and
atelectasis changes seen at base of the lung.
IMPRESSION: This is a 77-year-old female who presents with AFib with RVR. She had
episode where she had to be cardioverted, was in normal sinus rhythm for a while,
but has flipped back over to AFib with RVR. She is on amiodarone, she is on half
dose for protocol. We will try to get rhythm controlled. We will add home dose of
metoprolol. Need to be cautious due to lower blood pressure. We will check
magnesium for episodes of VT. We will also check thyroid because she has a history
of thyroid disease. AFib maybe due to COVID-19 infection. She is currently being
anticoagulated with Lovenox. We will also obtain echo. If heart rate continues to
be accelerated, we will cardiovert her again since she did have amiodarone bolus
and loading dose.
ABRAM BASINGER
D: **/**/**** 9:20:17 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22915025
CC:
CONSULTATION
CONSULTATION
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HISTORY OF PRESENT ILLNESS: The patient is a 77-year-old male who came into the
hospital for shortness of breath and syncopal episodes. The patient reports that
he was seated during the syncopal episodes, did not fall or sustain any sort of
injury. He has been feeling increasingly lightheaded and shortness of breath since
yesterday. Denies any sort of chest pain. On examination, pulse is 160, AFib with
RVR. He does not feel any palpitations. Blood pressures have been running soft,
he is on the Neo drip. He has a history of having COVID-19 last month. He also
has a history of bilateral pleural effusions with PleurX catheters in bilateral.
Right PleurX was removed about a week ago. The patient's last echo showed EF of
55%, moderate aortic regurgitation, moderate tricuspid regurgitation. No evidence
of any pericardial effusion. Last cath was in 08/2021. At that time left main was
patent, LAD mid with 30%, in-stent stenosis, left circumflex proximal with 80%, a
stent was placed at that time. Right ICA proximal and mid stents _____ ; PA 49,
17, 31; and _____ 33, 17, 17, 15.
PAST MEDICAL HISTORY: Coronary artery disease with stent placement in the past.
Hypertension. Recurring pleural effusion, bilateral PleurX placement. AFib, he is
on Eliquis for this. Hyperlipidemia, diabetes, and carotid stenosis.
SURGICAL HISTORY: He has a surgical history of PleurX placements on the right and
left side. Right carotid endarterectomy, thoracentesis in the past, and
tonsillectomy.
FAMILY HISTORY: Mother and father both having heart disease.
SOCIAL HISTORY: He is a former smoker. He admits to occasional alcohol use. No
illicit drug use.
ALLERGIES: He has no known allergies.
HOME MEDICATIONS: He is on colchicine, Eliquis, metoprolol, prednisone, Colace,
Glucotrol, Tradjenta, Lasix, Flomax, midodrine, and Plavix.
REVIEW OF SYSTEMS: A 10-point review of systems was negative unless noted above in
the HPI.
GENERAL: The patient is awake, alert, answering questions appropriately, not in
any acute distress. Heart rate elevated.
VITAL SIGNS: The patient afebrile at 97.6, respirations are 27, pulse is at 148,
blood pressure 84/53; he is on 4 liters nasal cannula, satting 100%.
LUNGS: Crackles in bases. No wheezes or rhonchi.
HEART: Rate and rhythm irregular. Tachycardic. No murmurs, gallops, or clicks
noted.
EXTREMITIES: No cyanosis, clubbing, or edema noted.
LABORATORY DATA: ProBNP elevated at 2608. Potassium is at 4.2. Creatinine is at
0.4. Hemoglobin is 12.8. ALT is at 77, AST is at 41.
DIAGNOSTIC TESTING: CT of the chest showed volume overload including interstitial
and alveolar edema, small right and small left pleural effusions, trace pericardial
effusion with ascites, and at least mild anasarca, mild-to-moderate bronchial wall
thickening potentially due to pulmonary vascular congestion, reactive airway
disease with bronchitis; no pneumothoraces.
IMPRESSION: This is a 77-year-old male who presents with AFib with RVR; however,
it is still elevated at 77. He has a history of PAF in the past, he had been
anticoagulated with Eliquis. He has not missed any doses. He has been on Cardizem
drip overnight. However, heart rate is still not responsive to Cardizem. We will
proceed with cardioversion this morning at bedside, and then proceed to load him
with amiodarone. We will continue to monitor liver function. He had elevated
liver function last time on the amiodarone. We will continue to trend labs. Still
has left-sided PleurX catheter placement and has small pleural effusion on left
side. Recommend draining after cardioversion. We will continue to monitor heart
rate and fluid status. We will continue to follow the case.
ABRAM BASINGER
D: **/**/**** 8:15:51 T: **/**/**** 9:41:03 AB/*******
Job#: ******* Doc#: 22913114
CC:
CONSULTATION
CONSULTATION
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INDICATION: Stroke-like symptoms.
HISTORY OF PRESENT ILLNESS: This is a 72-year-old female who presented to the
emergency department for falls. The patient fell in the bathroom after she had a
dream that she fell in the bathroom. Husband found her. After he found her, he
also was noticing left-sided weakness and left facial drooping and was sent to the
emergency department. The patient reported no loss of consciousness. CT of the
head was done when she was here. CT of the head and neck showed occlusion involved
with the proximal M2 branch of the right MCA in the region of the anterior right
MCA infarct and a 2 mm occlusion also seen from the left supraclinoid ICA and no
significant stenosis in bilateral ICAs. MRI pending the results. Neurology has
been consulted. We will get an echo to better evaluate. No history of any AFib.
EKG yesterday showed normal sinus rhythm with PACs, similar to what is seen in the
office
The patient has had an echo in the office. At that time, he had an EF of 57%, this
was on **/**/****. Left atrium is normal size. Normal right ventricular systolic
function. Possible bicuspid aortic valve at that time. Dilated ascending aorta at
4.3 cm. Mild AR and LAD in the left ventricle and diastolic pressure.
Also has a history of TIA at 4.1 cm. The patient has a history of stress
incontinence, osteoporosis, osteoarthritis, kidney stones, IBS, hypertension,
hyperlipidemia, migraines, colon polyps. Has a previous surgical history of wisdom
teeth extraction, hysteroscopy and colonoscopy. Mother and brother have a history
of coronary artery disease and father has a known AAA.
SOCIAL HISTORY: Does not smoke. Not using any alcohol or any illicit drugs.
ALLERGIES: She is allergic to SULFA ANTIBIOTICS, REMERON, STATINS, and TRAZODONE.
MEDICATIONS: Diltiazem, gabapentin, Ambien, Hyzaar, Toprol, potassium, Prozac,
Lasix, Zanaflex, Flonase, Fosamax, Zetia, and sumatriptan.
REVIEW OF SYSTEMS: Twelve-point review of systems is negative unless noted in HPI.
GENERAL: The patient is awake and alert, answering questions appropriately, not in
any acute distress. Left-sided facial droop noted.
VITAL SIGNS: Temperature 99.1, respirations are 14, pulse is 86, blood pressure
144/86. She is saturating at 94% on room air.
LUNGS: Clear. No wheezes, rhonchi or rales noted.
ABDOMEN: Soft and nontender. Bowel sounds are present in all four quadrants. No
EXTREMITIES: No clubbing, cyanosis, or edema noted.
NEUROLOGIC: Left facial droop noted.
LABORATORY RESULTS: Troponin is negative. Potassium is at 4.0. Creatinine is
1.1. Hemoglobin is at 14.6.
IMPRESSION: This is a 72-year-old who presented with stroke-like symptoms. CT of
the head and neck did show occlusion involving proximal M2 branch of the right MCA
and MRI is pending. Neurology is on board and does have positive facial droop.
From a cardiac standpoint, we will look at _____ negative for any AFib here.
Continue to tele. We will need outpatient heart monitor. We will get echo to look
at valves and any PFO. Continue to monitor, and we will make recommendations based
upon current hospital course.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22891221
CC:
CONSULTATION
CONSULTATION
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INDICATION: Cardiac arrest.
HISTORY OF PRESENT ILLNESS: The patient is a 55-year-old male who came to the
emergency department from a facility for altered mental status. In the emergency
department, he vomited and aspirated causing him to stop breathing. CPR was
started at that time. This was followed by two more episodes of cardiac arrest as
well during the stay in the emergency department. He has a history of hepatic
encephalopathy and that is why he is in the nursing facility. After the cardiac
arrest, hypothermic protocol was initiated; however, due to anemia and hemoglobin
of 6.4 with unknown source of bleeding and hypotension, hypothermic therapy was
ended. The patient was intubated, apparently ventilated. Blood pressure continued
to decrease. He is now on maximum dose of pressors. On admission, he was also
noted to be hyperkalemic, potassium 6.4. His creatinine was also 6.7. Lactic acid
was elevated at 12.4. GI, Nephrology, Pulmonology, and Endocrinology have all been
consulted on to the case. The patient has a history of an echo done on **/**/****.
At that time, left ventricular systolic function was normal. EF was visually
estimated at 55% and mildly dilated right ventricle. No evidence of any
PAST MEDICAL HISTORY: Arthritis; asthma; cerebral artery occlusion with cerebral
infarct; depression; thrombocytopenia; thyroid disease; spinal stenosis; pulmonary
hypertension; MRSA infection; hypertension; hyperlipidemia; DVT, on
anticoagulation.
PAST SURGICAL HISTORY: Bone marrow biopsy, colonoscopy, cyst removed from chin,
kidney biopsy.
SOCIAL HISTORY: Former smoker. He has EtOH. Denies any illicit drug use.
FAMILY HISTORY: No CAD found in the family history.
ALLERGIES: He has allergies to NUTS. Last time it was indicated as no allergies.
HOME MEDICATIONS: He is on midodrine, Protonix, Carafate, Norvasc, BuSpar, Celexa,
propranolol, Lasix, melatonin, potassium, Xarelto, Synthroid, folate, albuterol.
REVIEW OF SYSTEMS: Unable to complete as the patient is unresponsive and intubated
and ventilated.
GENERAL: The patient is intubated and sedated.
VITAL SIGNS: Temperature 97.3, respiratory rate 28, pulses of 70, blood pressure
81/57. He is on 100% FiO2 on ventilator.
LUNGS: Lung fields diminished in bases.
HEART: Rate and rhythm regular. No murmurs, gallops or clicks noted.
GI: Soft. Bowel sounds present in all four quadrants. No hepatosplenomegaly
noted.
EXTREMITIES: No clubbing or cyanosis noted.
NEUROLOGIC: Unable to assess.
LABORATORY DATA: Potassium 6.4, creatinine 6.7, troponin 0.064, lactic acid 4.4.
Hemoglobin 6.4. Blood pH 7.1, pCO2 of 58.
DIAGNOSTIC TESTING: CT of the head showed no acute intracranial abnormalities.
Small vessel ischemic changes. _____ examination. Chest x-ray showed interval
worsening severe infiltrates _____ to the left lung.
IMPRESSION: This is a 55-year-old male who presented to the emergency department
with altered mental status, appeared to aspirate leading to cardiac arrest, which
happened two or three times. He is now intubated, on pressors, in ICU. Family and
I discussed with hospitalist and he is now DNR-CCA. Continue pressor support.
Hyperkalemia, see nephrology. ProBNP elevated to 29,518. Echo scheduled to assess
EF after cardiac arrest. We will continue to follow along this case and make
recommendations accordingly.
The plan was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 8:40:13 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22891150
CC:
CONSULTATION
CONSULTATION
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MED REC NO: ******* ROOM: ED25
INDICATION: Chest pain.
HISTORY OF PRESENT ILLNESS: The patient is a 79-year-old male who presents to the
emergency department with chest pain. He was recently discharged from the hospital
on Friday, **/**/****. He was in the hospital for staged left heart cath. At that
time, he was found to have multivessel disease. Arrangements were made for a CABG
to be done on Tuesday and was sent home in stable condition. Yesterday, at home,
he was unable to pick up any of his medications until later in the day and ended up
taking medications late in the day right before the chest pain. At that time, the
chest pain was _____. Shortness of breath was associated with the chest pain.
Every time he does have an episode of chest pain, it seems to be more intense on
the left. He took three nitroglycerin and Scott gave him 325 of aspirin. Today,
he is stating that he is feeling well. Denies any chest pain or shortness of
breath. No dizziness or palpitations. Catheterization site healing well. No
bleeding or any signs of hematoma.
Echo was done on **/**/**** that showed left ventricle systolic function was
normal. EF was visually estimated at 53% to 55%. Left heart cath on **/**/****
showed left main patent, LAD mid 80% stenosis showing mild disease. LCX ostial 80%
stenosis. RCA ostial 80% stenosis and mid 80% stenosis. Pulmonary hypertension
was also noted when right heart cath was performed. CABG x2 was scheduled on
Tuesday with the CT Surgery here at Springfield Regional Medical Center.
PAST MEDICAL HISTORY: CAD, chronic low back pain, COPD, COVID-19, GERD,
hypertension, hyperlipidemia, sleep apnea, prostate CA, pulmonary hypertension,
PVD.
PREVIOUS SURGICAL HISTORY: Peripheral angioplasty, aortofemoral bypass graft,
appendectomy, heart cath, bilateral carotid endarterectomy, cholecystectomy,
colonoscopy and endoscopy, femoral bypass graft, left hip replacement, right knee
arthroscopy, lumbar diskectomy, total left hip arthroplasty.
SOCIAL HISTORY: Former smoker. Does endorse alcohol use and does not use any
illicit drug use.
FAMILY HISTORY: No known family history of CAD.
ALLERGIES: He is allergic to OXYCONTIN, VIOXX and STATINS.
HOME MEDICATIONS: He is on Mag-Ox, Imdur, Ranexa, Lipitor, Coreg, Lasix,
Aldactone, Protonix, Carafate, Zanaflex, Pletal, Plavix, Cozaar. Anticoagulations
are on hold for CABG on Tuesday.
REVIEW OF SYSTEMS: Ten-point review of systems otherwise negative unless noted
above in the HPI.
any acute distress.
VITAL SIGNS: The patient afebrile at 98.1, respirations are 14, pulse at 61, blood
pressure 134/58, satting 96%.
LUNGS: Clear to auscultation. No wheezes, rhonchi, or rales noted.
HEART: Rate and rhythm regular. No clicks, gallops, or murmurs heard.
ABDOMEN: Soft, nontender. Bowel sounds are present in all four quadrants.
Nondistended. No hepatosplenomegaly or guarding noted.
LABORATORY DATA: Troponins have been negative. Creatinine is at 1.0. Hemoglobin
12.9. Chest x-ray showed no acute findings of the chest.
IMPRESSION: The patient is a 79-year-old male who presented to emergency
department with chest pain. The patient was found to have multivessel CAD on the
CABG. CABG was scheduled to be on Tuesday. We will continue to watch the patient
until Tuesday, and we will plan on surgery on the given date. Cardiothoracic has
been consulted. Continue to hold anticoagulant medications for the surgery, and we
will continue to monitor for episodes of chest pain.
PLAN: We will continue to follow and make recommendations accordingly. This plan
was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 8:03:45 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22891147
CC:
CONSULTATION
CONSULTATION
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HISTORY OF PRESENT ILLNESS: This is an 87-year-old female who presented to the
emergency department in Urbana for ongoing chest pain and shortness of breath.
Chest pain is midsternal/epigastric chest pain. It feels like heaviness in the
chest and occurs frequently per the patient. She states that this has been
occurring frequently for a number of years. This has been occurring frequently for
quite sometime; however, it felt like it was intensifying on Monday, 11/08, felt
like it was intensifying at that time. The patient was recently hospitalized on
10/29 for shortness of breath and chest pain. At that time, it was found to have
right-sided heart failure and bacterial pneumonia. Today, the patient is resting
well. Blood pressure is elevated, currently on nitro drip. Troponin on admission
was 0.014, then it down to 0.013, and not elevated. Troponin on last admission was
more elevated than that.
Last echo was on **/**/****, at that time EF was 50 to 55%, severe tricuspid
regurgitation is present. RVSP was 65 at that time. Last stress test was done on
03/31, at that time it was negative for any cardiac ischemia. She did have a heart
cath done in 2017. Coronary arteries were opened at that time. It was ranged
branch that had 50% stenosis at that time and had mild disease.
PAST MEDICAL HISTORY: History of anxiety, arthritis, CAD, CKD, left nephrectomy,
pelvic fracture, hyperlipidemia, hypertension, osteoporosis and DVT.
PAST SURGICAL HISTORY: History of bilateral iliac angioplasties, carotid
endarterectomy, carpal tunnel release, cataracts, and then left nephrectomy.
FAMILY HISTORY: Hyperlipidemia, CAD, and hypertension.
ALLERGIES: CITALOPRAM, CELEXA, and SULFA ANTIBIOTICS.
SOCIAL HISTORY: She is a former smoker. Does not use any alcohol. Does not use
any illicit drugs.
HOME MEDICATIONS: She is on torsemide, Catapres, hydralazine, atorvastatin, Norco,
_____, warfarin, Ranexa, Zofran, potassium, Tylenol, Baclofen, amiodarone,
albuterol, vitamin D3, Plavix, and multivitamin.
REVIEW OF SYSTEMS: Ten-point review of systems is negative unless noted above in
the HPI.
any acute distress.
VITAL SIGNS: Temp is 100.2, respirations are 13, pulse is at 68, blood pressure
181/77. She is on 3 liters nasal cannula and sating at 97%.
LUNGS: Clear to auscultation. Slight crackles heard at the base of the lungs.
HEART: Rate and rhythm irregular. No clicks, gallops, or murmurs noted.
EXTREMITIES: Nonpitting lower extremity edema. No clubbing or cyanosis noted.
LABORATORY DATA: Potassium 3.6. Creatinine is 1.1. Latest troponin is less than
0.01. Hemoglobin is at 11.2, white blood cells are at 4.9. COVID-19 negative.
DIAGNOSTIC STUDIES: EKG shows atrial fibrillation having well controlled. Chest
x-ray shows persistent air space changes in the left middle and lower lung fields
_____.
IMPRESSION: This is an 87-year-old female who presented to the emergency
department with chest pain and shortness of breath, who just recently discharged
with chief complaint I found to have right-sided heart failure and pneumonia at
that time. Troponins continued to trend down at that time and has been chronic
complaint. Echo done on last admission. We will work on getting blood pressure
controlled. Continue to watch temperature for any signs of pneumonia. At this
time, no plans for cardiac catheterization or stress test. We will continue to
monitor. AFib, well controlled on Coumadin for anticoagulation. We will make
current recommendations based upon current hospital course.
ABRAM BASINGER
D: **/**/**** 9:01:11 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22885388
CC:
CONSULTATION
CONSULTATION
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HISTORY OF PRESENT ILLNESS: The patient is a 53-year-old man who presented to the
emergency department with chest pain and shortness of breath. Chest pain started
yesterday when he was sitting at home. Chest pain is midsternal, radiating across
the chest. It was a sharp stabbing pain, hence shortness of breath is associated
with it. He denied any feeling of palpitations, any dizziness, or any increased
lower extremity edema. The patient has history of end-stage renal disease and he
was just at dialysis on Saturday, he tolerated it well, and he has not missed any
dialysis session. He was recently hospitalized back in September, at that time he
had pericardial effusion with tamponade and 2.5 liters were removed at that time
with pericardial window. Today, CT scan showed that there is just small
pericardial effusion at this time. EKG showed AFib with heart rate of 111.
Troponin initially were negative.
Last echo on **/**/**** showed left ventricle systolic function, his hyperdynamic
EF was greater than 60%, small left ventricular cavity. The patient appears to
have _____ calcified anterior mitral valve without leaflet with restricted
movement, mitral stenosis, mean pressure gradient of 4 mmHg, mild tricuspid regurg,
RCP of 47, trace pericardial fluid noted, no significant pericardial effusion at
that time. Last heart cath was in 2014.
PAST MEDICAL HISTORY: The patient has a history of hyperlipidemia, insomnia,
seizures, depression, sleep apnea, thyroid disease, anemia, history of GI bleed,
history of anxiety, presyncope, end-stage renal disease, GERD, panic attacks, AFib,
diabetes, arthritis, and congestive heart failure.
PAST SURGICAL HISTORY: He has a previous surgical history of HD fistula creation,
kidney biopsy, colonoscopy, right hip surgery, pericardial window.
FAMILY HISTORY: Mother noted to have history of CAD. Father, sister, and brother
all has hypertension.
SOCIAL HISTORY: He does not smoke. Does have alcohol use about once a month. No
illicit drug use.
ALLERGIES: He has allergies to ACE INHIBITORS, LOSARTAN, SHELLFISH, and
VANCOMYCIN.
HOME MEDICATIONS: He is on Lopressor, midodrine, gabapentin, prednisone, Seroquel,
DuoNebs, Singulair, Cymbalta, Requip, Calcitrol, Synthroid, Nexium, vitamin D,
Mucinex, Flonase, and Eliquis.
REVIEW OF SYSTEMS: A 10-point review of systems negative unless noted above in the
HPI.
any acute distress.
VITAL SIGNS: Heart rate 104, AFib. Blood pressure 115/85. Temperature 97.7
degrees. He is satting 97% O2 on 4 liters.
LUNGS: Clear to auscultation.
HEART: Rate and rhythm irregular. No clicks, gallops, or distant heart sounds
heard.
ABDOMEN: Soft, nontender. Bowel sounds present in all four quadrants. No
EXTREMITIES: Nonpitting lower extremity edema. No clubbing or cyanosis noted.
LABORATORY DATA: Troponin less than 0.01. ProBNP greater than 70,000. Creatinine
7.6. Potassium is at 4. Hemoglobin is at 9.3.
DIAGNOSTIC TESTING: CT of the chest showed cardiomegaly with small bilateral
pleural effusions and pulmonary vascular congestion, small pericardial effusion,
bilateral lower lobe atelectasis, and finding of renal osteodystrophy.
IMPRESSION: This is a 53-year-old male who presents to the emergency department
with chest pain and shortness of breath that started yesterday. He has a history
of pericardial window, history of end-stage renal disease, and history of AFib.
Heart rate is currently in the 90s. Continue Cardizem drip. We will get another
echo to check on pericardial effusion and the severity of it. Chest pain and
shortness of breath ongoing, we will check another troponin and trend troponin to
see if there is any elevation. If there is any elevation, we would consider doing
a left heart cath at that time. I discussed with the patient and Nephrology, both
were agreeable to this plan. We will make further recommendations based on
hospital course.
ABRAM BASINGER
D: **/**/**** 7:41:30 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22870432
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: The patient is a 50-year-old female who presented to
the emergency department with chest pain. She recently had this chest pain back in
08/2021. The chest pain is midsternal pain, feels like a continuous pressure on
her chest. She first started experiencing this pain when she woke up this morning
and has been going throughout the day. She does endorse shortness of breath and
was diaphoretic with this chest pain. Chest pain is very similar what she had back
in August except this time it is intensified. Chest pain does not radiate anywhere
and was relieved with morphine and some nitroglycerin. Troponin was less than
0.010. Back in August, she had a stress test done at that time. Stress test was
negative for any ischemia or infarct. EF was 79%. She also had an echo done at
that time as well. Echo showed left ventricle systolic function is normal. EF is
50 to 60%. No significant valvular disease. No evidence of any pericardial
effusion. She recently had lost her daughter earlier this year.
PAST MEDICAL HISTORY: Hypertension, anxiety and obesity.
PAST SURGICAL HISTORY: She has no previous surgical history noted.
FAMILY HISTORY: No significant family history noted.
SOCIAL HISTORY: She is a current smoker, half pack a day. She does use alcohol.
No illicit drug use.
HOME MEDICATIONS: She is on atorvastatin, Coreg, omeprazole, Vistaril, losartan
and hydrochlorothiazide.
ALLERGIES: ASPIRIN.
REVIEW OF SYSTEMS: Ten-point review of systems is negative unless noted in the HPI
above.
GENERAL: The patient is awake and alert, answering questions appropriately here,
ill in appearance.
VITAL SIGNS: Afebrile, 97.6, respirations are 18, pulse is at 97, blood pressure
140/79. She is sating at 98% on room air.
HEART: Rate and rhythm regular. No clicks, murmurs, or gallops noted.
EXTREMITIES: No clubbing, edema or cyanosis noted.
NEURO: Cranial nerves II through XII are grossly intact.
LABORATORY DATA: Potassium 3.6. Creatinine is 0.6. Troponin is less than 0.010.
Hemoglobin at 14.
IMPRESSION: This is a 50-year-old female who presented to emergency department
with chest, just recently was in the hospital for chest pain at that time. A
stress test and echo was done, both reassuring. Same chest pain is occurring
today. This time intensified. Given her symptoms, we will go ahead and look at
doing a left heart catheterization, could have been balanced ischemia on stress
test. We will keep n.p.o. after midnight. Already on statin and beta-blocker;
however, she is unable to take aspirin due to allergy. Further recommendation
would follow hospitalization course. This plan was discussed with Dr. Najeeb
Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22870181
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: SVT.
HISTORY OF PRESENT ILLNESS: The patient is a 96-year-old female, who originally
came to the hospital for hypoglycemia. Apparently, she is not eating any food at
her nursing facility. She is pleasantly confused. The patient here at the
hospital, when she is getting upset, her heart rate would spike into the 140s and
150s, taking look at telemetry, it does appear that she is going into atrial
fibrillation during these episodes. She does have a history of PAF, was seen in
the office last year, was monitored and had over 400 episodes during that monitor
time. Never followed up with us after the monitor. Her last echo was in 2017. At
that time, normal left ventricular cavity with overall normal systolic function.
Irregular rhythm at that time. No evidence of any pericardial effusion. The
aortic valve is sclerotic, but not stenotic, mild MAC noted. The patient does
convert back to normal sinus rhythm. During the examination, she was in normal
sinus and during EKG today, was in normal sinus rhythm. However, during episodes
of excitement or anger, this is when she was into PAF.
PAST MEDICAL HISTORY: She has a previous medical history of colon cancer,
diabetes, CVA, closed head injury, syncope, renal insufficiency, anemia,
hypertension, TIA, and anxiety.
PAST SURGICAL HISTORY: She has a previous surgical history of hysterectomy,
dilated esophagus, and appendectomy.
FAMILY HISTORY: No known CAD in the family history.
SOCIAL HISTORY: She has not smoked. Does not have any alcohol use or illicit drug
use.
ALLERGIES: No known allergies.
HOME MEDICATIONS: She is on Zofran, buspirone, B12, warfarin, Zoloft, Amaryl,
folic acid, baby aspirin, Plavix, and Janumet.
REVIEW OF SYSTEMS: The patient is confused. Review of systems is not able to be
obtained.
GENERAL: The patient is awake and alert, presently confused, not in any acute
distress.
VITAL SIGNS: Afebrile at 97.9, pulse is at 83, blood pressure 158/79, she is
satting at 98% on room air.
HEENT: Head is normocephalic and atraumatic. Pupils are equal and reactive to
light.
CHEST: Equal in expansion.
HEART: Rate and rhythm regular.
LABORATORY DATA: The patient has a creatinine of 2.2, potassium 4.3, magnesium of
1.5.
IMPRESSION: This is a 96-year-old female, who has been consulted for SVT, actually
having episodes of AFib with RVR. We will defer on any anticoagulation given her
age and high risk of falling. She was hospitalized recently last year for multiple
falls. We will initiate beta-blocker to try to help control episodes of PAF and
replace magnesium. She does have AKI. Creatinine is stable at 2.2. She is
hypertensive due to holding losartan due to any nephrotoxicity medications. She is
a DNR-CCA and she is from Wooden Glen. We will try to control her beta-blocker and
continue making decisions along her case. This plan was discussed with Dr. Najeeb
Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22870174
CONSULTATION
CONSULTATION
***************
INDICATIONS: Atrial flutter and heart failure.
Urbana Emergency Department for new-onset shortness of breath and lower extremity
edema. The patient was recently being set up for bariatric surgery and was
unfortunately unable to do the surgery. She did stop all her medications days
before procedure. She has not seen cardiologist. Due to not taking her Lasix for
multiple days, she began to fill up with fluid and accumulated with shortness of
breath and lower extremity swelling. In the emergency department, she was also
found to be in atrial flutter. No history of atrial flutter before. No history of
any sort of heart disease. Does not follow with any cardiologist; however, family
does follow with our office and was requested.
PAST MEDICAL HISTORY: The patient has a history of diabetes, neuropathy, irritable
bowels, and morbidly obese.
PAST SURGICAL HISTORY: She has cholecystectomy and tubal ligation, left pinky
surgery, right groin abscess drainage and a hysterectomy.
FAMILY HISTORY: Mother and father had coronary artery disease and mother had
arrhythmias.
SOCIAL HISTORY: Does not smoke. Occasional alcohol use. Does not use any illicit
drugs.
CURRENT MEDICATIONS: She is on Norvasc, lisinopril, Lipitor, aspirin, Zoloft,
propanolol, Lantus, and Lasix.
ALLERGIES: She has allergies to _____, KEFLEX AND METFORMIN.
REVIEW OF SYSTEMS: Ten-point review of systems otherwise negative unless mentioned
in HPI.
any acute distress.
VITAL SIGNS: The patient is afebrile, 97.5, pulse is at 74, blood pressure 157/69,
oxygen is 94% on 4 liters.
LUNGS: Crackles in bases of chest.
HEART: Rate and rhythm irregular.
EXTREMITIES: 3+ lower extremity edema noted. No cyanosis or clubbing.
LABORATORY DATA: ProBNP 1212. Troponin is 0.028. Potassium is at 3.5, creatinine
at 1.1. Chest x-ray showed mild interstitial edema.
IMPRESSION: This is a 63-year-old female who presented to Urbana Emergency
Department with increased swelling, shortness of breath, and found to be in AFib
with RVR and found to be in atrial flutter. We will go ahead and get echo done on
her and no baseline to compare to. We will also diurese her with IV diuretics and
monitor her on telemetry. Strict I's and O's and daily weights. We will agree with
hospitalist starting beta blocker for atrial flutter. We will continue to watch
rhythm. This plan was discussed with Dr. Nkadi.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** 1:42:53 AB/*******
Job#: ******* Doc#: 22869855
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Mechanical aortic valve.
HISTORY OF PRESENT ILLNESS: The patient is a 56-year-old male who presented to the
Emergency Department today with altered mental status and unresponsiveness. The
patient was found by his wife and medics were called on the scene, hypotensive,
systolic blood pressure in the 60s and hypoxic. O2 sats were in the 60s as well.
Per patient's wife, the patient had been sick for months with nausea and vomiting,
also having blackish emesis. When the patient arrived to the emergency department,
the patient was anticoagulated with warfarin and baby aspirin. When the patient
arrived to the emergency department, he received 2 units of packed red blood cells
and 2 units of _____ and also started on pressors _____ decompensation was also
performed for concern of tension pneumothorax and chest tube was also inserted.
The patient is also intubated as well at that time. The patient has a history of
aortic valve replacement in 2006 with Dr. _____ mechanical valve and on
anticoagulation for the valve. Non _____ Coumadin INR on admission, INR in the
emergency department was 1.61. The patient does also have elevated lactic acid of
14.2 and glucose also elevated at 852 and lipase is elevated at greater than 3000.
The patient's hemoglobin was at 10.8.
Last echo done on the patient was in 08/2021. At that time, left ventricular
systolic function was normal. EF was visually estimated at 50% to 55%. Aortic
valve mean pressure gradient was 11 mmHg, _____ and no evidence of pericardial
effusion.
PAST MEDICAL HISTORY: He has a previous medical history of diabetes, CAD,
hypertension, hyperlipidemia, and aortic valve replacement.
PAST SURGICAL HISTORY: He has a previous surgical history of knee surgery,
cochlear implant in left ear, and then aortic valve replacement in 2009.
FAMILY HISTORY: He has no known family history of CAD.
SOCIAL HISTORY: He is a current smoker. No alcohol or illicit drug use.
HOME MEDICATIONS: He is on Robaxin, aspirin, Lantus, atorvastatin, metoprolol, mag
ox, amitriptyline, Norvasc, warfarin 10 mg on Mondays and 7.5 mg on every other day
on the rest of the days of the week, Norco, Keppra, gabapentin, albuterol, Nexium.
ALLERGIES: He has allergies to TRAMADOL.
REVIEW OF SYSTEMS: Unable to complete review of systems, as the patient is
intubated and sedated.
GENERAL: The patient is intubated and sedated.
VITAL SIGNS: Respirations are 14, pulse is at 81, blood pressure 81/58 _____, he
is sating at 100% on ventilator.
HEENT: Pupils are equal and reactive to light. Head is atraumatic and
normocephalic.
CHEST: Equal in expansion. Chest tube in place.
LUNGS: Diminished breath sounds in the bases.
HEART: Rate and rhythm regular. No murmurs, gallops, or clicks noted.
ABDOMEN: Soft, nondistended, nontender. Liver and spleen not palpable. Bowel
sounds present in all four quadrants.
EXTREMITIES: No cyanosis, clubbing or edema noted in the lower extremities.
DIAGNOSTIC TESTING: Chest x-ray showed endotracheal tube in place _____
thoracostomy tube is noted with trace residual in left apical pneumothorax _____
patchy opacities of the left lung nonspecific _____ pneumonia. CT of the abdomen
showed no evidence of extravasation in the gastrointestinal tract to suggest any
active intragastric bleeding during this exam, inflammatory changes in the second
portion of the duodenum suggestive of duodenitis with surrounding edema, small
amount of fluid, which may represent source of bleeding. No evidence of any
abdominal aortic aneurysms or dissections.
unresponsive with hemorrhagic shock; however, after blood transfusion was
delivered, IV fluids and pressors were given to stabilize the patient. GI had been
consulted to help _____ for GI bleeding. The patient has CKD and Nephrology has
been consulted. Elevated glucose and Endocrinology has been consulted. CT surgery
has been consulted for chest tube and Pulmonology has been consulted for
intubation. Echo was done 2 months ago. We _____ once stabilized. The patient
does have a history of mechanical aortic valve. Currently, on warfarin for
anticoagulation. We will continue to hold anticoagulation until bleeding has been
resolved then bridge back with the Coumadin until therapeutic. We will continue to
help with supportive care and make recommendations when appropriate.
This plan was discussed with Dr. Nkadi.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** 0:41:01 AB/*******
Job#: ******* Doc#: 22869841
CC:
CONSULTATION
CONSULTATION
***************
MED REC NO: ******* ROOM: TR01
INDICATION: ICD defibrillation.
HISTORY OF PRESENT ILLNESS: The patient is a 64-year-old male who presented to our
office originally for an INR check. While talking with the nurses, he mentioned
that his ICD went off last night. Nurses got interrogation of Medtronic rep read
it, and he did have an ICD firing for episodes of V-TACH. He was sent to the
hospital for further evaluation. The patient stated that he has been feeling more
lethargic over the last 3 to 4 days, noticed himself taking more naps of late. No
complaints of any chest pain or shortness of breath. No increased dizziness or
palpitation. He did feel like sometimes its off and just believes that his heart
went back into AFib. His ICD went off around 4 a.m. He woke up right before this
event happened and had a syncopal episode before the ICD fired. Today, he was
placed at bedside and complains of some discomfort from the firing and still
feeling very lethargic.
He had a Medtronic device generator changed last 11/2020, Medtronic ICD. Last
heart cath was in 2013, Dr. Dada.
PAST MEDICAL HISTORY: He has previous medical history of asthma, hyperlipidemia,
hypertension, CHF, diabetes, CAD, pneumonia, thyroid disease, COPD, hypothyroidism,
ascites, AFib, lymphedema in bilateral lower extremities, chronic ulcer in right
lower extremity, arthritis.
PAST SURGICAL HISTORY: Heart cath, ICD placement, colonoscopy, venous ablations,
atrial fibrillation, and dental extraction.
FAMILY HISTORY: He has a previous family history of mother, sister, and brother
all having heart disease.
SOCIAL HISTORY: He is a former smoker. He does not use any alcohol, does not use
any illicit drugs.
ALLERGIES: He has allergies to ROSUVASTATIN, SIMVASTATIN, GABAPENTIN, AND LIPITOR.
HOME MEDICATIONS: He is on home medications
1. Vitamin D3.
2. Oxycodone.
3. Metolazone.
4. Aldactone.
5. Lactulose.
6. Prilosec.
7. Albuterol.
8. Symbicort.
9. Potassium.
10. Zetia.
11. Flonase
12. Allopurinol.
13. Lantus.
14. Bumex.
15. Coreg.
16. Amiodarone.
17. Zyrtec.
18. Januvia.
19. Colchicine.
20. Robaxin.
21. Nitroglycerin sublingual.
22. Levothyroxine.
23. Coumadin.
24. Singulair.
25. Aspirin.
REVIEW OF SYSTEMS: Ten-point review of systems is negative unless noted in HPI.
any acute distress.
VITAL SIGNS: Afebrile, 98.4. Respirations at 28. Pulse is at 80. Blood pressure
110/65. Satting on room air 95%.
CHEST: Chest is equal and expansive.
LUNGS: Lungs are clear to auscultation.
EXTREMITIES: Bilateral lower extremities 1+ lower extremity edema. Chronic venous
ulcer of the left leg wrapped due to injury.
IMPRESSION: This is a 64-year-old male who presented to the Emergency Department
with ICD firing. The patient has had this done once before. This is when he had
been last time when his potassium levels were low. We will obtain labs. We will
obtain echo. We will get troponin to rule out any ischemic cause for V-TACH
causing the ICD to fire. It happened during nighttime. He was compliant with CPAP
at that time, does have history of sleep apnea. We will continue to trend labs and
look at laboratory data and determine treatment plan based on findings. This plan
was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22869250
CC:
CONSULTATION
CONSULTATION
***************
the emergency department with AFib with RVR. This was found when she was at Dr.
Andom's, her general surgeon. He is looking after a chronic venous ulcer on her
right leg. She was found to be AFib with RVR at office, also shortness of breath
and hypoxia with her O2 saturations being in the upper 80s. She reported that this
has been going on for the last couple of days beforehand. She has a history of PAF
and is on Xarelto, for anticoagulation. She denied any further palpitations. She
does endorse chest discomfort. She did have chest pain that occurred a couple of
days ago, but this is with an injury that came at her nursing home. She has 4+
lower extremity edema with venous ulcer on the right leg. She denies any
dizziness.
On 05/2020, Dr. Najeeb did an angiogram in the lower extremities. At that time, it
was found that the patient had minimal PAD and the ulcerations on her legs were
venous in nature. Latest echo in June showed left ventricular systolic function
and it was difficult to determine due to her arrhythmia. EF appeared to be at 40-
45%, left ventricular hypertrophy mildly dilated, left atrial aneurysm, interatrial
septum moderately dilated, right ventricle with moderate hypokinesis, mitral valve
heavily calcified, mild mitral stenosis, mean gradient at 6 mmHg with mild-to-
moderate tricuspid regurgitation.
PAST MEDICAL HISTORY: Obesity, edema, COPD, morbid obesity, osteoarthritis,
vitamin D deficiency, hyperlipidemia, chronic venous stasis dermatitis, nonpressure
chronic ulceration in the right lower leg, venous insufficiency bilateral legs,
edema of bilateral legs, PAF, right knee abscess.
PAST SURGICAL HISTORY: Tonsillectomy, umbilical hernia repair, varicose vein
surgery, right arm fracture.
FAMILY HISTORY: No significant family history of cardiac disease. Father did have
CVA.
SOCIAL HISTORY: Does not smoke. Does not use any alcohol. Does not use any
illicit drugs.
HOME MEDICATIONS: She is on Xarelto, Seroquel, metoprolol, digoxin, _____,
midodrine, Lasix, Lipitor, aspirin, and Tylenol.
ALLERGIES: She has allergies to SULFA ANTIBIOTICS.
REVIEW OF SYSTEMS: A 10-point review of systems negative unless noted in the HPI.
GENERAL: The patient is drowsy during the examination. Answers questions
appropriately. She is not in any acute distress.
109/76. She is on 4 liters of nasal cannula.
LUNGS: Clear to auscultation. No wheezes, rhonchi, or rales noted. Slightly
diminished in bases.
EXTREMITIES: A 2+ lower extremity edema in the right leg. Venous stasis ulcer.
No cyanosis or clubbing noted.
LABORATORY DATA: ProBNP is at 16,298. Troponin 0.02. Potassium at 4. Creatinine
is at 1.3. Hemoglobin is at 11. D-dimer is at 709.
DIAGNOSTIC TESTING: CT of the chest is negative for PE. The patient does have
larger intramuscular mass in the left pectoralis major likely hematoma, underlying
_____ not treated, clinically correlate and a mild mosaic attenuates in the lungs
with trace right pleural effusion.
IMPRESSION: This is a 69-year-old female who presented to the emergency department
with AFib with RVR coming from her doctor's office. Currently on Cardizem drip.
We will continue Cardizem until rate becomes well controlled. Resume oral
medications of the metoprolol and digoxin, both titrated medications if blood
pressure allows. We will obtain an echo. We will continue to trend troponin and
we gave another dose of IV Lasix this morning. Xarelto is currently being held due
to hematoma from injury at nursing home. We will continue to follow and make
decisions clinically based on findings.
The plan was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 7:54:51 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22867778
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: The patient comes in, a 49-year-old female, who has
followed up with us in the office, who came into the hospital today for chest pain
that radiate down into her left arm. This has been going on for about two days and
then yesterday it began to radiate down into her left arm. She was recently Soin
Hospital on **/**/****, where she was having chest pain at that time. They did do
left heart cath at that time. No critical stenosis is noted on heart cath and
medical management was recommended at that time. She also had abdominal aortogram,
abdominal angiogram with runoff, and that did not show any critical stenosis at
that time either. She is on aspirin, statin, and beta blocker at discharge from
cardiac standpoint. Chest pain felt like a stabbing pain going underneath her left
breast and then radiates into her arm where she feels like her arm is expanding.
EKG reviewed. No ST segment changes at all. Initial troponin was negative. We
will continue to trend. She had an echo at Ohio State on **/**/****, at that time
left ventricular size chamber was normal, EF was 60 to 65%, diastolic function was
normal, right ventricle chamber size was normal, systolic function was normal, no
significant valvular disease noted, no pericardial effusion. She does not complain
of any shortness of breath at this time. No edema. She does admit to having
palpitations in her chest. Normal sinus rhythm, however, on telemetry during these
palpitations in the room.
PAST MEDICAL HISTORY: COPD, asthma, anxiety, Sjogren syndrome, hypothyroidism,
migraines, slipped disc, substance abuse in the past with cocaine, hypertension,
DVT _____, and pneumonia.
PAST SURGICAL HISTORY: Cholecystectomy.
FAMILY HISTORY: Heart disease in her mother. No other pertinent family history.
SOCIAL HISTORY: She is a former smoker. Now, she does vape without any nicotine.
Does not use any alcohol. She has a history of cocaine use but has been seven
years clean.
ALLERGIES: She has allergies to BACTRIM, SULFA ANTIBIOTICS, VANCOMYCIN, and
CLARITHROMYCIN.
REVIEW OF SYSTEMS: A 10-point review of systems completed and negative unless
noted in the HPI.
any acute distress.
110/75. She is satting at 95% on room air.
HEART: Rate and rhythm regular. No murmurs, gallops, or clicks noted.
EXTREMITIES: No cyanosis or clubbing noted. Nonpitting edema noted.
LABORATORY DATA: Potassium 3.6, creatinine 0.4. Troponin negative. Hemoglobin is
13.3.
DIAGNOSTIC TESTING: CT of the chest, no evidence of any PE _____ throughout the
bilateral lung, suggestive of small airway disease. Chest x-ray showed no acute
cardiopulmonary process.
with chest pain. Recent cardiac catheterization done at Soin Medical Center showed
normal coronary arteries. We will start her on Ranexa to help with the discomfort
in the chest. We will obtain new echo of the chest. Troponin is negative. We
will continue to trend. We will also get proBNP. We will continue to follow along
this case.
This was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 8:39:29 T: **/**/**** 9:57:42 AB/*******
Job#: ******* Doc#: 22863972
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: The patient is a 66-year-old female who presents to
the Emergency Department with chest pain that had been going on for the last two
days. This chest pain has been getting produced when she has been having deep
coughs, and these coughs have been getting progressively worse. The chest pain
seem to start in the epigastric area and runs across the left side under her
breasts and into the back. It only seems present when she is coughing or when she
is moving about. There is some shortness of breath with it when she is coughing.
She describes it as aching-type pain. Troponins have been negative. Pro-BNP was
slightly elevated at 373. CT of the chest was negative for PE, but did show a left
upper lung mass with pleural base nodules in the left, pericardiophrenic lymph
nodes in the right, worrisome for metastasis. Oncology has been consulted. She
does not have any sort of swelling going on, and a history of COPD, oxygen at 3.5 L
which is her baseline, has history of obstructive sleep apnea on a CPAP. Last echo
was in 2019 and at that time showed EF greater than 55%, moderate left ventricular
hypertrophy, mildly dilated left atrium and right atrium, mildly dilated left
ventricle, and mild tricuspid regurg. EKG was negative for any sort of ST segment
elevation. Normal sinus rhythm on EKG.
PAST MEDICAL HISTORY: Anxiety, IBS, asthma, anemia, hypertension, hyperlipidemia,
COPD, emphysema, pneumonia, arthritis, shortness of breath, migraines, depression,
panic attack, acid reflux, chronic back pain, UTI, claustrophobia.
PAST SURGICAL HISTORY: Colonoscopy, bilateral cataracts, dental extraction,
tonsillectomy, tubal ligation, appendectomy, right ankle surgery.
FAMILY HISTORY: She has a family history of CAD, having heart attack with her
mother and brother.
SOCIAL HISTORY: She is a former smoker. No alcohol use. No illicit drug use.
ALLERGIES: She has allergies to CODEINE, TOPIRAMATE, CYCLOBENZAPRINE, HYDROCODONE,
TYLOXAPOL, HYDRALAZINE, OXYCODONE, ACETAMINOPHEN.
HOME MEDICATIONS: Pepcid, Atrovent, folic acid, Zyrtec, primidone, B12, BuSpar,
theophylline, losartan, propranolol, Phenergan, Advair, Plavix, Mucinex, Lipitor,
Mag-Ox.
REVIEW OF SYSTEMS: Ten point review of systems is negative unless stated prior in
the H and P.
any acute distress, wearing oxygen.
VITAL SIGNS: Afebrile 98.4, respiratory rate 18, pulse 85, blood pressure 138/48,
satting on 98% on 3 liters nasal cannula.
light.
LUNGS: Cough present, rhonchi present throughout lung field.
EXTREMITIES: No clubbing, cyanosis, or edema noted. Good pulses throughout.
LABORATORY DATA: Troponins are negative. Potassium 5.1. Creatinine 0.5. Pro-BNP
373. White blood cell count is at 12. Hemoglobin at 10. COVID-19 test negative.
DIAGNOSTIC TESTING: CTA of the chest showed a mildly enlarged pulmonary artery
suggestive of pulmonary hypertension, left upper lung hilar mass with pleural base
nodules in the left and the pericardiophrenic lymph nodes on the right worrisome
for metastasis, multiple masses within cutaneous soft tissue may represent
scattered narrow fibromas versus multiple cutaneous metastases, suggestive of
quadrant lesions identified. These could represent splenules versus metastasis.
Consider the CT of the abdomen and pelvis when clinically feasible.
IMPRESSION: This is a 66-year-old female who presented to the Emergency Department
with chest discomfort, found to have lung mass. Last echocardiogram was two years
ago. A repeat echo, chest pain does not appear to be cardiac in nature, likely
more related to a lung mass. The troponins have been negative. We will not get a
stress test at this time. Pro-BNP slightly elevated, but no edema noted on
examination. We will hold off on giving Lasix at this time. We will continue to
follow the case and follow the chest pain. This plan was discussed with Dr. Najeeb
Ahmed.
ABRAM BASINGER
D: **/**/**** 7:56:52 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22863913
CC:
CONSULTATION
CONSULTATION
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HISTORY OF PRESENT ILLNESS: The patient is a 79-year-old male who presents with
AFib with RVR, heart rate in the 150s. The patient states that he felt onset of
symptoms yesterday evening of palpations and rapid heart beat. The patient has a
history of AFib with atrial fibrillation with Dr. Gujja back in 01/2021. The
patient is taking Eliquis 5 mg t.i.d. prior to evaluation, not on any
antiarrhythmic or beta blockers. He is unable to tolerate beta blockers due to
orthostatic hypotension. Currently in room, his heart rate is between 80s to 100s
AFib only on oral diltiazem at this time.
Previous echo done **/**/**** EF of 65%, mild MR at that time. In office we did put
on Holter monitor 3 days at that time he had only three episodes at **/**/****. At
that time, he only had three episodes of PAF longest being 6 beats long, average
heart rate was at 74 beats per minute. He does deny any sort of lightheadedness,
dizziness, or near syncope. He does endorse slight shortness of breath,
palpitations.
PREVIOUS MEDICAL HISTORY: He has history of CAD, hypertension, hyperlipidemia,
osteoarthritis, and AFib.
PREVIOUS SURGICAL HISTORY: He has had hernia repair, cyst removal, atrial
fibrillation.
FAMILY HISTORY: He has no significant family history.
SOCIAL HISTORY: He has never smoked. He does have occasional alcohol use and he
does drink two cups of coffee daily.
MEDICATIONS: He is Eliquis, Lasix, Lipitor, multivitamin, Norvasc, and Protonix.
REVIEW OF SYSTEMS: Ten point review of systems is reviewed and negative unless
noted in the HPI.
GENERAL: He is awake and alert, answering questions appropriately, not in any
acute distress.
VITAL SIGNS: He is afebrile. His temp is 97.7, pulse at 102, blood pressure
123/81. He is satting at 95% on room air.
CARDIOVASCULAR: Heart rate and rhythm irregular.
LABORATORY DATA: Potassium is 3.5, creatinine is at 1, magnesium is at 2.
Troponin is negative. Hemoglobin is at 13.
IMPRESSION: The patient is a 79-year-old male who presented in the Emergency
Department with new onset of AFib last night having palpitations and feeling rapid
heart rate. Denies any dizziness, near syncope, lightheadedness. Slightly short
of breath. He denies any chest pain. The patient does have a history of atrial
fibrillation with Dr. Gujja at 01/2021. Currently anticoagulated with Eliquis. He
will continue oral diltiazem at this time. We will plan on proceeding with TEE
cardioversion tomorrow. He will be N.p.o. after midnight. We will also obtain
COVID test to make sure he is COVID-19 negative before this. This plan was
discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22850160
CC:
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INDICATION: CHF.
HISTORY OF PRESENT ILLNESS: The patient is an 80-year-old female who presented to
the emergency department with body aches, malaise, shortness of breath. She states
that all her symptoms started yesterday. She started having back pain that has
been going on between the shoulder blades, and shortness of breath at that time.
Also having generalized body aches, fatigue. She is not ambulatory. She has
wounds on the right lower extremity, seen by Wound Care and Dr. Conkel, outpatient.
When she arrived in the emergency department, she had an elevated temperature of
101.6. She lives with her granddaughter, has home healthcare. She was just
recently hospitalized in 08/2021, for a CHF exacerbation. She was diuresed and did
well. At that time, echo was also obtained. It showed left ventricular systolic
function was normal. Ejection fraction was visually estimated at 50% to 55%. No
evidence of any pericardial effusion at that time. Initial labs showed pro-BNP at
560, and troponin at 0.017. She is also having redness around the wound on her
right lower leg. X-ray of the right tibia showed edematous changes which could
represent cellulitis or implant edema.
PREVIOUS MEDICAL HISTORY: Hypertension, arthritis, chronic back pain, frequent
headaches, hyperlipidemia, CVA - no residual in 2014, glaucoma, depression, panic
attacks, anxiety, COPD, CHF, DVT on anticoagulation.
SIGNIFICANT SURGICAL HISTORY: Right shoulder surgery, _____, colonoscopy,
tonsillectomy, hysterectomy, left total knee, right ankle fracture repair.
FAMILY HISTORY: Mother had hypertension. No other cardiac history in the family.
SOCIAL HISTORY: She is a former smoker. Does not use any alcohol, does not use
any illicit drugs.
HOME MEDICATIONS: She is on Lasix, Spiriva, albuterol, Ambien, gabapentin,
Linzess, Robaxin, metolazone, potassium, Ranexa, Eliquis, Lipitor, Colace,
Oxybutynin, Xanax, hydrocodone, acetaminophen, and vitamin D3.
ALLERGIES: She has allergies to MORPHINE, CODEINE, ADHESIVE TAPE, ZANAFLEX.
noted in the HPI.
GENERAL: The patient is awake and alert, answering questions appropriately. She
is drowsy and a little short of breath during the examination.
VITAL SIGNS: Temp 101.6, respirations of 22, pulses are 102, blood pressure
115/89. She is satting at 97% on 2 L nasal cannula.
HEART: Rate and rhythm regular. Slightly tachycardic.
ABDOMEN: Soft, nontender. Bowel sounds present. No hepatosplenomegaly or
guarding noted.
EXTREMITIES: Right lower extremity redness, wound at distal tibia, 1+ edema.
DIAGNOSTIC TESTING: CTA pelvis showed a 2.5 cm solid cystic mass on the anterior
pole of the left kidney, highly suspicious for left renal cell carcinoma. Also
showed cardiomegaly with moderate congestion, and basal infiltrates in the lungs
reported on CT, tiny gallstones versus sludge, and no acute cholecystitis,
pancreatitis, or hydronephrosis. CTA of the chest showed central pulmonary
arteries are adequately _____. No large or central pulmonary embolus noted.
Moderate cardiomegaly, moderate interstitial congestion, bibasilar infiltrates also
noted. X-ray of the tibia and fibula showed stable, nonspecific, right lower
extremity edematous changes which could represent cellulitis or implant edema. No
osteomyelitis.
LABORATORY DATA: Lactic acid was 2.9, when she came in. It is now 1.7. Potassium
is 3.1, magnesium 1.6. Initial troponin was 0.017, 0.013, 0.016. White blood
cells 11.4, hemoglobin 12.0. Viral panel was negative.
IMPRESSION: This is an 80-year-old female, came in with aches, pains, general
fatigue, shortness of breath, elevated heart rate, febrile, and elevated lactic
acid and leukocytosis, sepsis of unclear source. She does have troponins that are
detectable; however, she is complaining of no chest pain, has no EKG changes at
all. No ACS suspected. We will replace electrolytes. We just had an echo last
admission. We will not repeat at this time. We will give a dose of IV Lasix this
a.m. and get her to watch for fluid retention and respiratory status. Primary team
with antibiotics will continue to follow along this case. This plan was discussed
with Dr Nkadi.
ABRAM BASINGER
D: **/**/**** 8:23:01 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22849947
CC:
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the emergency department, has AFib with RVR. This is new onset yesterday. The
patient woke up from a nap, and she said that she was feeling her heart racing and
shortness of breath. The patient was found to be in the 160s to 170s at that time,
AFib with RVR. EMS stated the patient was in SVT, so 6 mg and then 12 mg of
adenosine was given without any improvement. She was about to be started on a
Cardizem drip here at the emergency department when she then spontaneously
converted, now in normal sinus rhythm. She does have a history of PAF. She is
currently on Coreg and Xarelto anticoagulation. She had recently been feeling ill
and having vomiting and diarrhea as well. Electrolytes, magnesium and potassium
were low. She had an echo in office on **/**/****. EF was 57 at that point, left
atrium dilated at 4.5, RV systolic function was normal, pulmonary artery pressure
35, mild aortic regurgitation, status post mitral valve repair, mean gradient at
3.7 mmHg, mild to moderate regurgitation, diastolic dysfunction.
PAST MEDICAL HISTORY: She has a previous medical history of hypertension,
hyperlipidemia, seizures, CAD, and PAF.
PAST SURGICAL HISTORY: She has a previous surgical history of a hysterectomy; CABG
x3 with mitral valve repair; thoracentesis, bilateral lungs; and a TEE
cardioversion. The last one was done in 2016
FAMILY HISTORY: She has no significant family history.
SOCIAL HISTORY: A former smoker, rare alcohol use, and does have marijuana use.
HOME MEDICATIONS: She is on Norvasc, Lipitor, folic acid, Dilantin, Brodtek,
Xarelto, Cozaar, Microzide, Plavix, Coreg, Coumadin, Depakote, baby aspirin,
pravastatin.
ALLERGIES: She has no known allergies.
noted in the HPI.
any acute distress.
VITAL SIGNS: The patient is afebrile, 97.4, respirations are 16, pulse is at 74,
Blood pressure 177/94. She is satting at 94% on room air.
LUNGS: Clear to auscultation. No wheezes, rhonchi, or crackles noted.
HEART: Rate and rhythm regular. No gallops, murmurs, or clicks noted.
NEUROLOGIC : Cranial nerves II through XII are grossly intact.
LABORATORY DATA: Potassium is 3.4, magnesium 1.7. Troponin is negative. TSH
9.09, hemoglobin 15, creatinine is 0.7.
with AFib with RVR. She spontaneously converted on her own. Does have a history
of PAF. Continue Xarelto and Coreg at this time. This episode happened after she
woke up from a nap. She also admits to having poor sleep at night. This could
possibly be sleep apnea related. We recommend getting an outpatient sleep study.
We will replace electrolytes due to loss of electrolytes due to vomiting and
diarrhea. We will also check an echo at this time. This plan was discussed with
Dr. Nkadi.
ABRAM BASINGER
D: **/**/**** 7:57:51 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22849944
CC:
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INDICATION: Ventricular aneurysm.
HISTORY OF PRESENT ILLNESS: The patient is a 65-year-old male with MRDD, who
presented to emergency department originally on **/**/****. He was originally
brought in from the group home for recent falls. During initial workup, he was
found to have an elevated lipase consistent with pancreatitis and cholecystitis.
During the evaluation, CT of the abdomen and pelvis was done and on that CT, we
found a 5.8 x 5.5. x 5.3 mass arising from the anterior wall of the left ventricle
most consistent with ventricular aneurysm; so we will get an echo to re-evaluate.
Last echo 2006, found to have an EF 50% to 55%. Ventricular aneurysm was noted at
that time, also no pericardial effusion at that time. In 2016, he also had left
heart cath. He had angioplasty of the LAD with one stent placed at that time.
Information was hard to obtain for the patient being MRDD, was nonverbal with me.
Information had been obtained from reviewing the chart.
PAST MEDICAL HISTORY: He has a history of present illness of MRDD, cardiac
tamponade, bipolar, asthma, Parkinson's, hypothyroid, and psoriasis.
PAST SURGICAL HISTORY: He has a previous surgical history of thoracentesis and
cardiac catheterization with stent placement, and dental restoration.
FAMILY HISTORY: He has no known family history.
SOCIAL HISTORY: He does not smoke. Denies any alcohol use. Does not use any
illicit drugs. He does live at a group home.
ALLERGIES: He has allergies to ACYCLOVIR, BACTRIM, AND CAFFEINE.
HOME MEDICATIONS: He is on ibuprofen, calcium carbonate plus vitamin D, ferrous
sulfate, furosemide, sertraline, Tegretol, Plavix, aspirin, Lipitor, lisinopril,
gemfibrozil, Xyzal, levothyroxine, Risperdal, and Artane.
GENERAL: The patient is awake. He is answering questions by shaking his head. He
appears to be in pain at this time.
VITAL SIGNS: Temperature 99.1. Respirations are 18. Pulse is at 101. Blood
pressure 121/67. He is saturating at 95% on 2 liters.
HEENT: He is normocephalic and atraumatic. Pupils equal and reactive to light.
CARDIAC: Irregular rate. Rhythm regular. Slightly tachycardic.
ABDOMEN: Soft. Bowel sounds present in all four quadrants. No guarding, no
rebound tenderness.
LABORATORY DATA: Potassium is at 3.6. Creatinine is at 1.1. His proBNP is
slightly elevated at 1275. Hemoglobin 8.2.
DIAGNOSTIC TESTING: CT of the abdomen showed lower lobe pulmonary consolidation
and coarctation consistent with atelectasis and pneumonia, a 5.8 x 5.5 x 5.3 cm
mass arising from the anterior wall in the left ventricle and there is some
significant ventricular aneurysm. Findings are consistent with pancreatitis. No
peripancreatic fluid collection, abscess or free air; however, pancreatitis
necrosis could not be excluded from the study. Diffuse infiltrative changes
throughout the inferior and anterior perirenal space. Degenerative disk disease at
L4 through L5 with spinal canal stenosis, neural foraminal stenosis and nerve
compression.
IMPRESSION: This is a 65-year-old MRDD who presented with pancreatitis. General
Surgery had been following. They were unable to get hold of a legal guardian to
proceed with surgery, but we were unable to get consent. Because of that, at this
point, we are going to set up for a surgery outpatient. On CT of the abdomen, we
found to have left ventricle mass. The finding is more consistent with a
ventricular aneurysm. On echo, in 2016, there appears to be an apical aneurysm of
the left ventricle at that time as well. We will repeat echo study. He could
shake his head now for any sort of chest pain. We will hold off on doing any
further stress test at this time. We will continue monitor heart beat and blood
pressure, and we will continue to follow.
ABRAM BASINGER
D: **/**/**** 8:15:52 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22848149
CC:
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MED REC NO: ******* ROOM: OBS02
HISTORY OF PRESENT ILLNESS: The patient is a 65-year-old female, who presented to
the emergency department with chest pain. This chest pain first started after
walking for greater than 10 minutes, feels like the chest pain is also noted with
some shortness of breath as well. EKG shows nonspecific ST segment changes.
Troponin has been negative. She is also recently discharged from the emergency
department two days ago with esophageal food bolus _____ with esophageal
strictures. She has not had stress test or echo done in the last five years.
PAST MEDICAL HISTORY: She has previous medical history of asthma.
PAST SURGICAL HISTORY: No known surgical history.
FAMILY HISTORY: She does not have any family history of CAD.
SOCIAL HISTORY: She does not smoke, does not use alcohol, does not use any illicit
drugs.
HOME MEDICATIONS: She takes omeprazole.
ALLERGIES: She has allergies to ERYTHROMYCIN.
GENERAL: She is awake and alert, not in any acute distress, answering questions
appropriately.
VITAL SIGNS: The patient is afebrile 97.8, respiration 24, pulse 72, blood
pressure 149/80, and she is sating 99% on room air.
LUNGS: Clear to auscultation. No wheezes or rhonchi.
CARDIOVASCULAR: Heart rate and rhythm regular.
hepatosplenomegaly.
EXTREMITIES: No edema, clubbing, or cyanosis noted.
LABORATORY DATA: Sodium is 128, potassium 42, creatinine 0.2. Troponin negative.
ProBNP _____ shows a hemoglobin of 14.
DIAGNOSTIC TESTING: Chest x-ray showed no acute processes.
IMPRESSION: This is a 65-year-old female, who presented to the emergency
department with chest pain. This chest pain was after exertion after walking for
10 minutes. Chest pain was associated with shortness of breath and was relieved
with nitroglycerin. Chest pain feels like ache and burning sensation, but it does
not feel like her normal GERD. Initial troponin is negative. EKG showed slight ST
segment changes. No cardiac workup done in the past. We will rule out ACS. We
will get stress test and echo, also get CT of the chest. We will continue to
follow the case. This plan was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22847845
CC:
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MED REC NO: ******* ROOM:
***************
INDICATION: Elevated troponin.
HISTORY OF PRESENT ILLNESS: The patient is a 90-year-old female who came into the
Emergency Department with complaints of cough, congestion, fatigue, fever, and
malaise. She was recently seen at the hospital and discharged on **/**/****. At
that time, she was complaining of the headache and high blood pressure at that
time. She has been vaccinated for COVID-19. She is also having increased
shortness of breath. Denies any sort of chest discomfort, any swelling in her
legs, or any dizziness.
She recently had an echo, left ventricular systolic function is normal, EF was
about 50 to 55%, grade 2 diastolic function, mild-to-moderate aortic stenosis, mean
gradient is about 13 mmHg, mitral valve annular calcifications present. No
evidence of any pericardial effusion. Technically difficult study. Troponin was
elevated to 0.116, a proBNP 2504. EKG reviewed, no ST segment changes from
previous EKGs.
PAST MEDICAL HISTORY: She has a previous medical history of CHF, arthritis, gout,
neutrophilic leukocytosis, uterine cancer, shortness of breath, aspiration
pneumonia, sepsis, situational depression, and hypercholesterolemia.
PAST SURGICAL HISTORY: She has a previous surgical history of right hip surgery,
left knee arthroplasty, foot surgery, pericardial window in 2013, cataracts
removal, EGD, hysterectomy, and right femur fracture.
FAMILY HISTORY: Father and mother both are having CA.
SOCIAL HISTORY: She has never smoked. Currently having alcohol use. Does not use
any illicit drugs.
ALLERGIES: She has allergies to LATEX, CIPRO, ROCEPHIN, ASPIRIN, KEFLEX,
PENICILLIN, PREDNISONE, and AMLODIPINE.
HOME MEDICATIONS: She is on magnesium peroxide, losartan, allopurinol, Prilosec,
atorvastatin, Plavix, potassium chloride, Prozac, Xarelto, and ferrous sulfate.
She is also to have known _____.
GENERAL: The patient is awake and alert, hard of hearing, answering questions
appropriately.
VITAL SIGNS: Temperature 98.4, respirations are 17, pulse is at 69, blood pressure
107/40, saturating 97% on room air.
LUNGS: Diminished in the bases. Slight crackles throughout the bases. No
wheezing noted.
EXTREMITIES: No clubbing or cyanosis. Some nonpitting edema noted.
LABORATORY DATA: Potassium 4.4. Creatinine is at 1.7. ProBNP elevated at 2504.
Troponin 0.116. Hemoglobin 11.2. She is negative for COVID-19.
IMPRESSION: This is a 90-year-old female who presents to the Emergency Department
for fever, cough, and increasing shortness of breath. On laboratory results, found
to have elevated troponin at 0.116. She is not having any acute chest pain, no EKG
changes, likely elevated troponin secondary to shortness of breath and infection,
demand ischemia. If troponins continue to trend elevated, we will begin doing a
left heart cath at that time. ProBNP elevated with shortness of breath. I gave
one-time dose of IV Lasix, very cautious due to creatinine of 1.7. Echo done last
admission, would not need to repeat. Continue to hold off any beta-blockers,
episodes of bradycardia on last admission. We will continue to follow.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22847782
CC:
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emergency department with chest pain. Chest pain came on today after coming home
from work. He felt chest discomfort and he felt like his heart was pounding
strongly in his chest. When he was lying down in the room, it became wavy around
him. The patient was just recently discharged from the observation unit on 10/12.
He came in for very similar symptoms. Troponins were negative at that time. Echo
was obtained, left ventricular systolic function is normal. Ejection fraction is
visually estimated at 50 to 55%, left ventricle size was normal. No regional wall
abnormality at that time. There was some concentric left ventricular hypertrophy,
mild-to-moderate pulmonic regurg present at that time, and mild AS noted. The
patient was discharged to home on home oxygen at that time as well. He was
supposed to follow up in the office for Holter at discharge. EKG reviewed here in
the emergency department showed normal sinus rhythm. Telemetry at bedside showed
normal sinus rhythm. Reviewing labs, troponin was negative. The patient states
that he has been very nervous and anxious of late. He has been under a lot of
stress. Also talked about caffeine intake, he drinks about five to six cans of
soda a day.
PAST MEDICAL HISTORY: He has a previous medical history of hypertension, diabetes,
cataracts, pneumonia, acid reflux, anxiety, depression, kidney stone, and CAD.
PAST SURGICAL HISTORY: Cardiac catheterization, lymphoma resection, aortic valve
replacement in 2019, tonsillectomy and adenoidectomy.
FAMILY HISTORY: Brother with heart disease. Mother with heart disease.
SOCIAL HISTORY: Does not smoke. Does not use any alcohol and does not use any
illicit drugs.
HOME MEDICATIONS: Nitro, atorvastatin, Lipitor, Aldactone, Trileptal, Protonix,
Risperdal, Xarelto, metformin, Coreg, aspirin, Wellbutrin, potassium chloride,
Zoloft.
GENERAL: The patient is awake and alert, not in any acute distress, answering
questions appropriately.
VITAL SIGNS: Afebrile 98.1, pulse 71, blood pressure 135/87, oxygen at 93%.
RESPIRATORY: Lungs are clear to auscultation. No wheezes, rhonchi, or rales
noted.
CARDIAC: Heart rate and rhythm regular. No clicks, gallops, or murmurs.
EXTREMITIES: No clubbing, cyanosis, or nonpitting edema noted.
LABORATORY DATA: Troponin is negative. ProBNP 29.9. Creatinine 0.8. Potassium
3.9. Hemoglobin 11.9.
with chest pain. These symptoms are very similar to what he came in for two days
ago. Cardiac standpoint is still stable. No additional testing at this time. We
will obtain Holter monitor outpatient to look for believed palpitations, to rule
out any arrhythmia. Palpitations deemed to come with higher anxious moments. We
talked about cutting back on caffeine and trying to work on relaxation techniques.
He will follow up in the office in a couple of weeks.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22847756
CC:
CONSULTATION
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INDICATION: Chest pain, palpitations.
HISTORY OF PRESENT ILLNESS: The patient is a 29-year-old male who presents to
emergency department for chest discomfort. The chest discomfort started yesterday
after waking up. He was also having extreme episodes of near syncope and dizziness
upon standing. After these episodes, he became short of breath at that time and
felt like his heart was racing. The patient has a history of Wolff-Parkinson-White
syndrome, status post ablation in 2013 with a Dr. Chen _____. He also has had a
loop recorder placed in 2015 by Dr. Karabatak. The patient describes chest
discomfort as epigastric, crushing type pain. Did not get worse with exertion. No
shortness of breath directly with the pain.
Near syncope noted shortly upon trying to stand. He had a history of vasovagal and
neurocardiogenic syncope in the past. The patient has not seen his primary or
cardiologist within the past five years. He also has a history of seizures, but no
seizure like activity in over **-year-old.
PAST MEDICAL HISTORY: He has a previous medical history of WPW and seizures.
PAST SURGICAL HISTORY: He has a previous surgical history of WPW ablation.
FAMILY HISTORY: He has family history of CHF.
SOCIAL HISTORY: Currently smokes a half a pack a day. Does not use any alcohol.
Does use marijuana, marijuana found in urine as well.
MEDICATIONS: He does not take any home medications.
ALLERGIES: DERMABOND.
GENERAL: The patient is awake and alert, answering questions appropriately and not
in any acute distress.
VITAL SIGNS: The patient is afebrile at 98.1, respiratory rate 18, pulse is at 86,
blood pressure of 141/89. He is satting at 100% on room air.
CARDIAC: Rate and rhythm regular. No murmurs, gallops or clicks noted.
ABDOMEN: Soft, nontender. Bowel sounds present in all 4 quadrants. No
EXTREMITIES: No clubbing, cyanosis or edema noted.
LABORATORY DATA: Troponin is negative. Creatinine at 1.2. Potassium 4.6.
Hemoglobin 16.2. D-dimer not elevated. Positive for marijuana detected in urine.
DIAGNOSTIC TESTING: CT of head showed no acute intracranial abnormalities. Chest
x-ray showed no radiographic evidence of acute pulmonary abnormalities.
with chest pain, near syncope and dizziness and shortness of breath and these
symptoms happened also yesterday. He has a history of WPW with ablation in the
past and had vasovagal syncope in the past as well. We will continue to trend
troponin. We will obtain echo while here. EKG showed normal sinus rhythm. No ST
segment changes at all. Chest pain has lessened significantly. We will make sure
that he has Holter monitor as an outpatient to better evaluate for any sort of
arrhythmia. Loop recorder could not be interrogated due to battery life, it was
placed six years ago. We will continue to follow this. Discussed with Dr. Najeeb
Ahmed.
ABRAM BASINGER
D: **/**/**** 8:37:01 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22844247
CC:
CONSULTATION
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Abram Basinger, CNP dictating for Najeeb Ahmed, MD
INDICATION: Syncopal episode.
HISTORY OF PRESENT ILLNESS: The patient is a 90-year-old female who originally
presented to the Enon ER for a syncopal episode. Episode originally came when she
was trying to get out of the van into her wheelchair. Per granddaughter, she has
not been feeling like herself all day. She was going shopping with her
granddaughter, when she got up from the chair, she had a syncopal episode. After
that, granddaughter got her back in car and drove her to the Enon Emergency
Department, where she had a syncopal episode when trying to get inside as well.
She has never had a history of this in the past and granddaughter said that she is
also having increasing tremor-like activity, has had a history of tremors in the
past, especially restless leg syndrome. In the emergency department, a 12-lead
showed normal sinus rhythm, left axis deviation, but no arrhythmias. Troponins are
negative.
She has had a stress test one year ago, and it showed no ischemia or infarct noted.
Echo from a year ago showed left ventricular systolic function as normal, EF was
visually estimated at 50 to 55, grade 1 diastolic dysfunction, sclerotic, but non-
stenotic aortic valve, mild-to-moderate aortic regurgitation, mild mitral
regurgitation, mitral annular calcification present, no evidence of pericardial
effusion. Carotid ultrasound was also done at that time, bilateral ICA has been
less than 50%.
PAST MEDICAL HISTORY: She has a previous medical history of hypertension, restless
legs, she is blind in both eyes, she has had a history of colon cancer, depression,
CVA, arthritis, pneumonia, GERD, COPD, tremors, and dementia.
PAST SURGICAL HISTORY: She has a previous surgical history of hysterectomy, spine
surgery, abdomen surgery, appendectomy, vascular surgery, back surgery, and eye
surgery.
FAMILY HISTORY: She has a family history of daughter having hypertension and
mother having hypertension and heart disease.
SOCIAL HISTORY: She is a former smoker. She does not use any alcohol. She does
not use any illicit drugs.
HOME MEDICATIONS: She is on Paxil, Foltx, Namenda, donepezil, baclofen, aspirin,
atorvastatin, ReQuip, hydralazine, vitamin B12, and albuterol.
ALLERGIES: She has a nonspecific allergy to an ANTIBIOTIC.
GENERAL: The patient is awake and alert, confused and answering questions, not in
any acute distress.
VITAL SIGNS: Temperature 98.1, respirations are 21, pulse 78, blood pressure
148/77, oxygen saturation 94% sating on room air.
CARDIOVASCULAR: Rate and rhythm regular.
LABORATORY DATA: Troponins have been negative x2. Urine positive for leukocytes,
bacteria and white blood cells. Creatinine 0.8, potassium 3.5, and hemoglobin
10.4.
DIAGNOSTIC TESTING: CT of the head negative, no acute intracranial abnormalities.
IMPRESSION: This is a 90-year-old female, who presented to the emergency
department for syncopal episode witnessed by her granddaughter. Today, currently
she is resting comfortably in the bed, no episodes of dizziness or near syncope.
Normal sinus rhythm on telemetry and stress test. Carotids done last year. We
will repeat echocardiogram at this time. Blood pressure and heart rate are stable
at this time. The nature of syncope upon standing could be orthostatic in nature.
We will obtain echocardiogram. She will likely need a Holter monitor as an
outpatient. We will continue to follow and make recommendations. This plan was
ABRAM BASINGER
D: **/**/**** 8:20:44 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22844220
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: The patient is a 48-year-old male, who presents to the
emergency department with chest. This chest pain has been going on since morning.
He woke up with chest discomfort. Chest discomfort is epigastric, feels like
bricks are sitting on top of him, tender to palpate, and reproducible. The patient
also has a history of EtOH abuse, with his last drink being yesterday, where he
states he drank about a gallon of beer at that time. The patient has had left
heart cath in 2018, no blockages were found at that time, aneurysm, coronaries
suggestive of Kawasaki disease. He had an echo done in March. The patient has
also had ablation in the past. The patient had echo in March showed left ventricle
systolic function is normal. EF was visually estimated at 50 to 55%, structurally
normal mitral valve, tricuspid valve not well visualized, and no evidence of any
PAST MEDICAL HISTORY: He has a previous medical history of GERD, chronic kidney
disease, seizures, herniated disc, alcohol abuse, kidney stones, AFib,
hypertension, nephritis, thyroid disease, CAD, DVT, CVA, and gout.
PAST SURGICAL HISTORY: He had a previous surgical history of gastric bypass, knee
surgery, kidney surgery, appendectomy, cholecystectomy, colonoscopy, pacemaker
insertion, tonsillectomy, exploratory abdominal surgery, and _____ revision.
FAMILY HISTORY: Mother has a history of hypertension and CVA.
SOCIAL HISTORY: He is a current smoker, drinks a gallon of liquor a day. No
illicit drug use.
HOME MEDICATIONS: Augmentin, Zithromax, Protonix, Cardizem, Xanax, acetaminophen,
gabapentin, Xarelto, Synthroid, _____ amiodarone, Lipitor, multivitamin, Ambien,
and Seroquel.
GENERAL: The patient is awake and alert, having tremors from alcohol withdrawal,
diaphoretic. Able to answer any questions appropriately.
VITAL SIGNS: Afebrile 98.2, pulse 106, blood pressure 131/90, he is sating at 95%
on room air.
LUNGS: Clear to auscultation. No wheezes, rhonchi, or crackles noted.
CARDIOVASCULAR: Rhythm and rate regular.
ABDOMEN: Tender to palpation, nondistended, bowel sounds present, no guarding
noted.
LABORATORY DATA: Potassium 3.4, troponins were negative, creatinine is 0.6. ALT
is at 65, AST is at 106. Hemoglobin at 12.3.
IMPRESSION: This is a 48-year-old male, who presents to the emergency department
with chest pain also EtOH withdrawal. He is currently incarcerated and came from
jail. The patient has had left heart cath in the past claiming coronaries at that
time. Troponins are negative. We will continue to try and get echo at this time.
He does have a history of AFib. Continue on medications. He also has permanent
pacemaker insertion as well. Chest pain seems to be epigastric pain reproducible.
We will get stress test to rule out ACS. This plan was discussed with Dr. Najeeb
Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** 0:44:56 AB/*******
Job#: ******* Doc#: 22830724
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Chest pain and AFib.
HISTORY OF PRESENT ILLNESS: The patient is a 69-year-old male, who presented to
the emergency department with chest pain, also found to be in AFib with RVR at that
time. Since then, he has compared it to normal sinus rhythm with the help of
Cardizem drip. Today, chest pain is still present, but has been improving. He
does admit to having shortness of breath whenever he exerts himself. This has been
going on for quite sometime and has been getting progressively worse. He had an
echo in 01/2021, EF 50 to 55% at that time, left ventricular systolic function is
normal, mildly dilated right ventricle, no significant valvular regurgitation or
stenosis noted. No evidence of pericardial effusion. Troponins have also been
elevated, when he came in it was 0.098, today it was 0.835 this morning.
PAST MEDICAL HISTORY: He has previous medical history of hypertension, chronic
pain, acute kidney injury, alcohol abuse, GERD, osteoarthritis, diverticulitis,
hiatal hernia, and head injury.
PAST SURGICAL HISTORY: He has a previous surgical history of appendectomy.
FAMILY HISTORY: His mother had heart failure and heart disease. His father and
siblings all have hypertension.
SOCIAL HISTORY: He is a former smoker, half pint of alcohol, half pint of beer
admitted. He does not use any illicit drugs, but does use controlled narcotics for
pain.
HOME MEDICATIONS: He is on morphine, Coreg, Amitiza, and Norvasc.
ALLERGIES: He has allergies to VICODIN and SIMVASTATIN.
GENERAL: Awake and alert, and answering questions appropriately, not in acute
distress.
VITAL SIGNS: Temperature 98.2, respirations are 22, pulse 85, blood pressure
144/74, he is sating at 96 liters on room air.
CHEST: Equal expansion.
LUNGS: Clear to auscultation. No wheezes or rhonchi noted.
CARDIOVASCULAR: Rate and rhythm regular.
ABDOMEN: Soft and nontender. No bowel sounds present in all quadrants. No
hepatosplenomegaly noted or guarding noted.
LABORATORY DATA: Troponin 0.835, lactic acid 2.1, potassium 3.8, and creatinine
2.1.
DIAGNOSTIC TESTING: CT of the chest, no evidence of TEE or acute pulmonary
abnormality, marked hepatic steatosis, and severe degenerative changes at bilateral
glenohumeral joint.
IMPRESSION: This is a 69-year-old male, who presented to the emergency department
for chest pain and accelerated heart rate, heart rate now controlled. Cardizem
drip, he is currently off of it. Currently, started on Eliquis, anticoagulation,
and Coreg for rhythm control, marked elevated troponin. We will proceed with a
left heart cath tomorrow. N.p.o. after midnight. He does have history of AKI, we
will consult Nephrology to help with his kidneys, he has normal saline going into
his IV right now. He is having chest pain and has progressive shortness of breath
with exertion. We will also obtain echo. This plan was discussed with Dr. Najeeb
Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** 0:17:02 AB/*******
Job#: ******* Doc#: 22830718
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: The patient is a 59-year-old male who presented to
Urbana Emergency Department for chest pain. Chest pain has been going on and off
for the last couple of months, perhaps seasonal. This episode on Friday lasted 2
to 3 hours, which is a longest it had occurred. The patient decided to go to the
Emergency Department. These episodes of chest pain occur at random, feels like
somebody is sitting across his chest when he is having chest pain. Does feel some
shortness of breath with this, mostly chest pain does occur when sitting down, not
with exertion. Troponins were run and troponins have been negative. EKG was
negative for any ST segment changes. The patient does have a history of a CABG in
the past, on aspirin, statin, and beta-blocker. He also has a history of PAF, he
is on amiodarone and Xarelto.
He had echo done, **/**/****, that showed left ventricular systolic pressure is
normal, EF estimated at 50%. No significant valvular disease. No evidence of
impaired cardiac effusion at that time. He also has a history of PE. He is on
Xarelto for that as well. Last month went to the Emergency Department three times
for chest pain. Troponins were negative at that time.
PAST MEDICAL HISTORY: Sleep apnea, hypertension, hyperlipidemia, arthritis, CAD,
history of migraines, gastric ulcers, diabetes, shortness of breath, atelectasis in
his lung, and PE.
PREVIOUS SURGICAL HISTORY: Coronary artery bypass graft, LIMA to LAD and diag, SVG
to OM and RCA, cholecystectomy, knee surgery, tonsillectomy, and bilateral carpal
tunnel release.
FAMILY HISTORY: He has a family history of grandfather, father and brother all
having heart disease.
SOCIAL HISTORY: He has a social history of never smoking and occasional alcohol
use. No illicit drug use.
HOME MEDICATIONS: Trazodone, Seroquel, Crestor, meclizine, Ultram, Lipitor,
amiodarone, Depakote, Xarelto, metformin, Lopressor, Aricept, Lantus, Cogentin,
Zoloft, Flonase, Claritin, Prilosec, baby aspirin, B12.
ALLERGIES: HE HAS ALLERGIES TO DOXEPIN, NIACIN, PLAVIX AND VENLAFAXINE.
any acute distress.
VITAL SIGNS: The patient is afebrile at 98, respiratory rate is 17, pulse is 71,
blood pressure 124/85, oxygen sat is 93%.
LUNGS: Clear to auscultation. No wheezes or rhonchi or rales noted.
CARDIOVASCULAR: Regular rate and rhythm.
hepatosplenomegaly noted or guarding noted.
EXTREMITIES: No cyanosis, clubbing or edema noted.
NEUROLOGIC: Cranial nerves II to XII are intact.
LABORATORY DATA: Troponin negative. ProBNP was elevated at 1200. Creatinine was
at 1.7, potassium at 3.9. Hemoglobin at 11.8.
DIAGNOSTIC TESTING: Chest x-ray showed no acute cardiopulmonary abnormalities.
Scarring for atelectasis in the left lung base is unchanged.
IMPRESSION: This is a 59-year-old man who presented to the emergency department
with chest discomfort. The patient has a history of CABG x4 in 01/2021. Chest
pain comes and goes. It has resolved since coming in. He also admits to having
shortness of breath when is having chest pain, but not shortness of breath at this
time. Troponins have all been negative. EKG showed no ST segment elevation. He
has normal sinus rhythm on the monitor on tele. Blood pressure has remained
stable. Chest pain did not occur with exertion, but he does describe it as
heaviness, like somebody is sitting on his chest consistent with _____. We will
continue to see what the troponin is this morning and EKG. May need stress test as
an outpatient due to the fact that all symptoms have resolved. This plan was
discussed with Dr. Nkadi.
ABRAM BASINGER
D: **/**/**** 8:19:51 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22830487
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Shortness of breath and edema.
the emergency department yesterday with increased shortness of breath. She was
getting up to the bathroom on Saturday morning when she became very short of breath
during this. Her cousin decided to call the Squad because of the shortness of
breath. She was recently hospitalized for acute congestive heart failure and was
on torsemide. At that time, she was also in AFib with RVR, on diltiazem and digoxin
as well as Xarelto for anticoagulation. Initial labs showed elevated potassium,
elevated pro-BNP, and slightly elevated troponin. She has a history of severe
pulmonary hypertension and always had some shortness of breath at baseline. She
does admit that legs have been increasingly swelling over the past couple of days;
however, did not take her weight daily.
She had echo **/**/****, that showed left ventricular systolic function is
hyperdynamic. Ejection fraction is estimated to be greater than 60 had some
severely dilated right ventricle with flattening of the interventricular septum
indicative of prior _____ severe tricuspid regurg, RVSP 80 mmHg, severe pulmonary
hypertension noted. No evidence of pericardial effusion _____
PAST MEDICAL HISTORY: She has a previous medical history of hyperlipidemia,
hypertension, osteomyelitis, acute on chronic diastolic congestive heart failure,
AFib.
PAST SURGICAL HISTORY: Hysterectomy, bilateral knee replacements, colonoscopy,
EGD.
SOCIAL HISTORY: Never smoking, no alcohol use, no illicit drug use.
FAMILY HISTORY: She does not have any significant family history of coronary
artery disease.
HOME MEDICATIONS: Demadex, potassium, Xarelto, Zyloprim, digoxin, midodrine,
diltiazem, Arava, Celexa, prednisone, Lipitor, Prilosec.
GENERAL: Awake and alert, answering questions appropriately, not in any acute
distress.
VITAL SIGNS: Afebrile 97.7, respiratory rate 19, pulse is 93, AFib, blood pressure
148/68, satting 100% on 4 L.
Hard of hearing.
LUNGS: Diminished lung sounds in the bases. No wheezes or rhonchi noted.
hepatosplenomegaly. No guarding noted.
EXTREMITIES: No clubbing, no cyanosis noted. 1+ lower extremity edema.
LABORATORY DATA: Potassium is 5.2, creatinine is 1.5, these are both down from
yesterday. Pro-BNP is 21,541. Troponin 0.058. Hemoglobin 12.0.
DIAGNOSTIC: Chest x-ray shows evidence of findings suggestive of congestive heart
failure, superimposed but simply cannot be excluded.
IMPRESSION: This is an 80-year-old female who presented to the emergency
department with increasing shortness of breath and CHF exacerbation. Continue IV
diuretics. Pro-BNP elevated. Also presented with acute kidney injury, and
creatinine is trending down, continue to monitor. Also continue to monitor
potassium which is also trending down. She also presents with AFib with RVR. Rate
is decently controlled now. Continue diltiazem. We will recheck dig levels, then
restart home dig dosing. Continue to watch blood pressure. Can necessitate some
beta blocker if blood pressure allows. We will continue to trend troponin, see how
troponin is this morning; however, she does not have any general chest discomfort.
Echo was recently done. We will not repeat. We will continue to follow the case.
ABRAM BASINGER
D: **/**/**** 7:51:43 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22830478
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: The patient is an 84-year-old female who is getting
consulted for AFib with RVR. She recently presented to the hospital for increasing
shortness of breath, found to have COVID pneumonia. She is having episodes of AFib
with RVR and heart rate going into the 110s to 120s. Was started on diltiazem
drip, since then has been turned off. She has a history of chronic AFib, is on
Coumadin at home, has not been following up in the office. Echo was done
yesterday, left ventricular systolic function was normal. EF was visually
estimated at 65%, moderate left ventricular hypertrophy, mild-to-moderate aortic
regurg, mitral annular calcification noted. No evidence of any pericardial
effusion.
PAST MEDICAL HISTORY: Hypertension, CHF, and AFib.
PAST SURGICAL HISTORY: Back surgery, tonsillectomy, and knee surgery.
SOCIAL HISTORY: She never smoked. She did not use any alcohol. She did not use
any illicit drugs.
FAMILY HISTORY: Negative family history.
ALLERGIES: She has allergies to LOSARTAN, DARVON, and SULFA ANTIBIOTICS.
HOME MEDICATIONS: Coumadin, Coreg, digoxin, and Lasix.
any acute distress.
VITAL SIGNS: The patient is afebrile at 97.5. Respiratory rate is at 16. Pulse
is at 90. Blood pressure 109/76. She is satting at 94% on 4 liters of nasal
cannula.
LUNGS: Clear to auscultation. No wheezes, rales, or rhonchi noted.
ABDOMEN: Soft, nontender. No guarding noted. Bowel sounds present. No
hepatosplenomegaly noted.
EXTREMITIES: No clubbing or cyanosis noted. Some nonpitting edema noted.
LABORATORY DATA: Potassium 3.6, creatinine 1.0. Troponin negative. ProBNP on
admission was elevated at 1500. Hemoglobin is at 16. INR is 0.99. D-dimer 235.
IMPRESSION: This is an 84-year-old female who presented to the hospital with
COVID-19 pneumonia, went into AFib with RVR, history of chronic AFib. Heart rate
elevated likely due to infection. We will help control heart rate. We will add 25
mg of Lopressor and restart her home digoxin. Echo already completed. Preserved
EF. At this time, it does not appear to be fluid overloaded. We will have to
bridge with heparin until INR is in the therapeutic range. Continue on telemetry.
We will continue to monitor.
ABRAM BASINGER
D: **/**/**** 8:35:39 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22825056
CC:
CONSULTATION
CONSULTATION
***************
INDICATIONS: AFib with RVR.
emergency department for increased edema and shortness of breath. This has been
getting progressively worse since Sunday. The patient has been noticing increased
shortness of breath with swelling in his lower extremities as well as his abdomen.
At home, he tried to take extra doses of furosemide, but did not seem to help,
which ultimately led him coming into the emergency department. Heart rate in the
emergency department was in the 130s, AFib with RVR. The patient has history of
chronic AFib. Last echo was in 06/2020, which showed that left ventricular
systolic function is normal. EF visually estimated at less than 20%. Moderate
biatrial enlargement. Moderate-to-severe mitral regurg. Moderate-to-severe
tricuspid regurg consistent with moderate pulmonary hypertension. No evidence of
any pericardial effusion.
PAST MEDICAL HISTORY: Hypertension, CHF, and AFib.
SOCIAL HISTORY: He has never smoked. Occasional alcohol use. No illicit drug
use.
FAMILY HISTORY: Coronary artery disease on his father side.
HOME MEDICATIONS: Amiodarone, lisinopril, metoprolol, Aldactone, allopurinol,
hydralazine, furosemide, Lipitor, Eliquis, and baby aspirin.
any acute distress.
VITAL SIGNS: The patient is afebrile, 98.2, respirations are 19, pulse is in the
130s, blood pressure 136/114. He is satting at 100%.
LUNGS: Diminished in the bases.
HEART: Heart rate and rhythm irregular, tachycardic.
ABDOMEN: Distended. No guarding noted. Active bowel sounds. No
hepatosplenomegaly noted.
EXTREMITIES: No clubbing or cyanosis. A 2+ lower extremity edema.
LABORATORY RESULTS: Potassium is at 3.6, creatinine is at 3.3, proBNP is at 2794,
troponin 0.079. Hemoglobin 13.4.
DIAGNOSTIC TESTING: Chest x-ray showed cardiomegaly, prominence of pulmonary
vasculature which could indicate pulmonary vascular congestion.
IMPRESSION: This is a 47-year-old male presents with edema and shortness of breath
and AFib with RVR. We will get rate controlled on IV diltiazem and also restart
home medications in efforts to get heart rate down. Also continue diuretics. The
patient does have acute kidney injury with renal function being 3.3. Nephro has
been consulted. ProBNP is elevated and troponin is elevated as well. Troponin
elevated more likely due to fluid overload and AFib. He also has been on heart
failure medication for sometime and EF shows less than 30. We will repeat echo to
check EF. May benefit from ICD in the future.
ABRAM BASINGER
D: **/**/**** 8:04:21 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22825010
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Chest pain and shortness of breath.
emergency department after speaking with his nephrologist, Dr. Varghese. The
patient sees Dr. Varghese for an essential hypertension, and at that time, he was
found to have increased creatinine. Today, creatinine is at 2.6, potassium is at
5.5. The patient also has been complaining of increased lower extremity edema,
increased shortness of breath and chest discomfort that has been going on and has
been progressively worse over the last couple of months. The patient has crushing
pain in the middle of his chest often accompanied with shortness of breath. He has
3+ lower extremity edema, on diuretics per Nephrology. He had an echo done last
year, at that time left ventricular systolic pressure was normal, EF was 50 to 55%,
mild-to-moderate mitral regurgitation present, grade 2 diastolic dysfunction noted.
He also had a stress test at that time, which showed no EKG changes suggestive of
ischemia, normal _____ uptake, moderate reversible perfusion defect noted in the
inferolateral wall _____ showed EF of 39%, PAD also noted; clinical correlation.
PAST MEDICAL HISTORY: Diabetes, diabetic neuropathy, GERD, hypertension,
hyperlipidemia, and mitral valve prolapse.
PAST SURGICAL HISTORY: Right shoulder surgery, EDD, and wisdom tooth extraction.
SOCIAL HISTORY: He is a current smoker. Occasional alcohol use. No illicit drug
use.
ALLERGIES: He has no known drug allergies.
FAMILY HISTORY: Heart disease on his father's side. High blood pressure on
brother.
HOME MEDICATIONS: He is on insulin, Aldactone, hydralazine, Catapres, Lantus,
Norvasc, Cozaar, Coreg, Farxiga, Celexa, torsemide, Amaryl, Lipitor, Humalog, and
Protonix.
any acute distress.
VITAL SIGNS: The patient is afebrile at 98 degrees. Respiratory rate 17. Pulse
58. Blood pressure 155/61. He is satting at 98% on 3 liters on room air. He is
396 pounds.
light.
HEART: Regular rate and rhythm.
ABDOMEN: Soft and nontender. Bowel sounds are present in all four quadrant. No
EXTREMITIES: 3+ lower extremity edema.
LABORATORY DATA: Potassium 5.5, creatinine is at 2.6. Hemoglobin at 10.9.
DIAGNOSTIC DATA: Chest x-ray today, no acute pulmonary disease, stable
cardiomegaly, without evidence of overt failure.
with worsening renal failure. He does admit to having chest pain, shortness of
breath, and increased edema. Given this, we will get stress test and echo. We
will also get a set of troponin. He is very hypertensive. Nephrology will handle
hypertensive medication. Acute renal disease as well, will be careful with any IV
contrast. We will continue telemetry and make recommendations based on findings.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22823668
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Tachycardia.
HISTORY OF PRESENT ILLNESS: The patient is a 62-year-old male who is getting
consulted for tachycardia. The patient was found to be tachycardic and hypotensive
during the episode of dialysis today. He is on 25 mg of Coreg b.i.d. He
originally came in to the hospital for hypotension during dialysis treatment. The
patient also had moderate right pleural effusion; with thoracentesis, 450 mL of
fluid was removed today.
PREVIOUS MEDICAL HISTORY: Diabetes, hypertension, anxiety, cerebral artery
occlusion with cerebral infarction, CAD, end-stage renal disease, hyperlipidemia,
and chronic diastolic heart failure.
PREVIOUS SURGICAL HISTORY: Right inguinal hernia repair, tonsillectomy, left knee
arthroplasty, cholecystectomy, and left BKA.
SOCIAL HISTORY: Never smoked. He has not used any alcohol intake. No illicit
drug use.
FAMILY HISTORY: Mother needed a pacemaker. Father and sister has had
hypertension.
HOME MEDICATIONS: He is on Tylenol, Mucinex, Humalog, Lantus, labetalol, Protonix,
Pletal, Zocor, Imdur, aspirin, and Zofran.
any acute distress.
VITAL SIGNS: Temp 99.3, respirations are 16, pulse is at 114, BP 95/58. He is
satting at 94% on room air.
LUNGS: Clear to auscultation. No wheezing or rhonchi noted.
HEART: Heart rate tachycardic. Regular.
ABDOMEN: Soft, nontender. No hepatosplenomegaly or guarding noted.
EXTREMITIES: Left BKA. Right leg; no clubbing, cyanosis or edema noted.
LABORATORY DATA: Potassium at _____, creatinine 3.3. Hemoglobin at 10.2.
DIAGNOSTIC TESTING: Echo last month, EF 50%. Left ventricular systolic function
is normal.
IMPRESSION: This is a 62-year-old male who is being seen for tachycardia. Heart
rate in the 100s to 110s. We will get the patient on telemetry. Continue to
monitor heart rate. He is on beta-blocker. Blood pressure has resolved. We will
continue to trend blood pressure and add medications when blood pressure allows.
Continue Coreg for now. I am possibly looking at _____ diltiazem if blood pressure
allows. Echo done last month. No need to repeat. Continue Pletal, Zocor, and
baby aspirin.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22823604
CC:
CONSULTATION
CONSULTATION
***************
MED REC NO: ******* ROOM: H06
Abram Basinger, APRN - CNP dictating for Najeeb Ahmed, MD
HISTORY OF PRESENT ILLNESS: This is a 67-year-old female who urgently presented to
the emergency room for left ear bleeding. Etiology of this bleeding is unknown.
She is on Xarelto due to AFib. Recommended her to follow with ENT, outpatient.
While she was in the emergency department, was having episodes of chest discomfort
and chest pain. She has had this pain on and off for some time. She is scheduled
to have a coronary angiogram on Friday at Ohio State. She describes the pain as
precordial and she described it as a crushing-type pain. She had a heart cath in
2020. At that time, LAD had 50% stenosis, RCA had moderate to severe disease. At
that point, it was unchanged from previous heart cath. Medical treatment was done
at that time. Last echo in 2020 showed left ventricle systolic function was
normal. EF is visually estimated at 50%. Mild left ventricular hypertrophy,
mildly dilated left atrium, no evidence of any pericardial effusions. She does
have a history of ICD, Boston Scientific. Also has risk factors of diabetes,
hypertension, and hyperlipidemia.
PREVIOUS MEDICAL HISTORY: CAD, hyperlipidemia, depression, diabetes, hypertension,
asthma, CHF, GERD, AFib, sleep apnea, and chronic hypoxic respiratory failure, uses
home oxygen.
PREVIOUS SURGICAL HISTORY: Hysterectomy, right knee surgery, cholecystectomy,
carpal tunnel release, ICD placement, and tubal ligation.
SOCIAL HISTORY: Never smoked. No alcohol use. No illicit drug use. She has a
family history of mother having hypertension, hyperlipidemia, and heart disease.
ALLERGIES: She has allergies to CEFACLOR, CODEINE, CEFUROXIME, DARVON, DEMEROL,
FENTANYL, LEVOFLOXACIN, MORPHINE, NICKEL, DURAGESIC, TETRACYCLINES AND RELATED,
VANCOMYCIN, CLINDAMYCIN, HUMALOG, and NOVOLOG.
HOME MEDICATIONS: She is on Zofran, Glucotrol, Lantus, Zanaflex, Jardiance,
levothyroxine, Humalog-Novolog mix, Xarelto, Toprol XL, Requip, ramipril, Crestor,
Lasix, potassium, Ranexa, sotalol, Mucinex, albuterol, Norco, Folvite, and baby
aspirin.
any acute distress.
VITAL SIGNS: The patient is afebrile at 98.3. Respiratory rate at 21. Pulse
about 102. Blood pressure 140/67. O2 sat is at 97.
Dried blood noted on the exterior left ear.
CHEST: Expands equal, bilateral.
HEART: Regular rhythm and rate.
ABDOMEN: Nontender, nondistended. No guarding noted. No hepatosplenomegaly
noted.
LABORATORY DATA: Troponins are negative. ProBNP is not elevated. Potassium is at
3.9. Creatinine is at 0.6. Hemoglobin 13.8.
DIAGNOSTIC TESTING: Chest x-ray showed stable chest with elevated left
hemidiaphragm with mild left basilar atelectasis. No obvious superimposed acute
processes.
IMPRESSION: This is a 67-year-old female who is being seen for left ear bleeding,
but is also having episodes of chest pain. She is supposed to have coronary
angiogram at OSU on Friday. History of PAF and ICD insertion. I talked to her
this morning, chest pain is still present, has not gotten any worse. The troponins
have all been negative. Angiogram last year showed that there is moderate amount
of disease in coronaries. Talked to her about doing coronary angiogram here while
she is here at the hospital. Last Xarelto dose was on Sunday. She is going to
think about this and let us know. Also interrogated pacemaker today. Continue to
trend troponin. We will check echo as well to look at EF.
ABRAM BASINGER
D: **/**/**** 7:54:18 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22823088
CC:
CONSULTATION
CONSULTATION
***************
INDICATIONS: Chest pain.
ER for chest pain. Chest pain started last night around 10 o'clock and had gotten
progressively worse around 3 o'clock. He woke up from the sleep with chest pain.
Chest pain is mid to left sternal. He describes it as a sharp pain. Troponin has
been negative so far. He has a history of CAD requiring multiple angioplasties in
his lower extremities over the years. Last echo was in 11/2020. It showed left
ventricular systolic function is hypodynamic; EF is greater than 60; moderate left
ventricular hypertrophy; sclerotic, but non-stenotic aortic valve; no evidence of
pericardial effusion; grade I diastolic dysfunction.
PAST MEDICAL HISTORY: He has a previous medical history of hypertension,
hyperlipidemia, PVD, neuropathy, carotid artery stenosis, CKD, AAA, syncope, PAD,
arthritis, glaucoma, prostate CA.
PREVIOUS SURGICAL HISTORY: Previous angioplasties in the lower extremities,
cholecystectomy, tonsillectomy, colonoscopy, AAA repair in 2019.
SOCIAL HISTORY: He is a former smoker. Does not use any alcohol. Does smoke
marijuana.
FAMILY HISTORY: Father and sister have CAD. Both brothers have hypertension.
HOME MEDICATIONS: He is on omeprazole, Bentyl, Linzess, Pletal, Lipitor, Catapres,
Norvasc, Eliquis, hydralazine, Aldactone, Coreg, Flomax.
GENERAL: The patient is awake, alert, and oriented, not in any acute distress,
answering questions appropriately.
VITAL SIGNS: Afebrile at 97.7. Respiratory rate 19. Pulse 82, normal sinus
rhythm. Blood pressure 162/104. He is satting at 98% on room air.
CARDIAC: Regular rate and rhythm.
ABDOMEN: Soft. Nontender. Bowel sounds are present. No hepatosplenomegaly or
guarding noted.
LABORATORY DATA: Creatinine 11.7. Potassium 4.6. Troponin negative. ProBNP not
elevated. Hemoglobin is at 13.9.
DIAGNOSTIC TESTING: CTA of the chest showed no evidence of any pulmonary embolism
or acute pulmonary abnormalities.
Chest x-ray showed hyperinflation of the lungs, COPD, no acute process seen.
IMPRESSION: This is a 71-year-old male who presents with chest pain, has extensive
history of PAD in the past requiring angioplasties. Given his history, we will do
cardiac workup. We will get echo and stress test to rule out ACS. We will also
work on getting blood pressure better controlled. We will continue to trend
troponin.
ABRAM BASINGER
D: **/**/**** 9:48:22 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22821289
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: AFib.
the hospital with increased fatigue and weakness. The patient began feeling ill at
the beginning of the month of September. It has been progressively getting worse.
On admission, the patient has been recovering from COVID which she got earlier this
month as well. Has been trying to rehydrate herself orally, but has been having
poor oral intake. She has a history of AFib. Rate is in the 100s to one teens at
the moment. She is also found to be supratherapeutic on admission. INR on
admission was greater than could be analyzed and then repeat was greater than 10.1.
A one time dose of subcutaneous vitamin K was given this a.m.
PAST MEDICAL HISTORY: She has a previous medical history of osteoporosis,
arthritis, hyperlipidemia, anxiety, AFib, diverticulitis, GERD, IBS, fatty liver,
hypertension, DVT, anemia, vertebroplasty.
PAST SURGICAL HISTORY: She has a history of previous surgical history of right hip
surgery, colonoscopy, cholecystectomy, vertebroplasty, and left hip surgery.
FAMILY HISTORY: She has no CAD in her family history. Does have a _____ history
of COPD in her family.
ALLERGIES: She has allergies to AUGMENTIN, ATORVASTATIN, ENTEX, LIPITOR,
PRAVASTATIN, PENICILLIN, and RED DYE.
HOME MEDICATIONS: She is on vitamin D, Ambien, Percocet, Colace, calcium,
Calcitrate, vitamin B12, Lopressor, Protonix, Norvasc, Coumadin, vitamin D3.
any acute distress.
VITAL SIGNS: The patient is afebrile, 97.6; heart rate is at 98, AFib; blood
pressure 129/57; saturating at 94% oxygen on 6 liters; respirations are at 21.
HEENT: Head is atraumatic, normocephalic. Pupils are equal and reactive to light.
LUNGS: Decreased breath sounds bilaterally in the bases.
ABDOMEN: Soft, nontender. Bowel sounds are present. No hepatosplenomegaly noted.
EXTREMITIES: No edema, clubbing, or cyanosis noted.
LABORATORY DATA: Hemoglobin is at 9.9. INR greater than 10.1. SARS-CoV-2 test
detected positive for COVID. Calcium is at 4. Creatinine is at 1.8.
DIAGNOSTIC TESTING: CT of the chest showed mild bilateral pulmonary hypertonic
changes with superimposed patchy consolidation and ground-glass opacities,
bilateral, which is _____ suggestive of pneumonia.
IMPRESSION: This is an 83-year-old female who presented to the hospital with
increased weakness and fatigue after having COVID-19 infection. Found to have
supratherapeutic INR and AFib with RVR. We will titrate Lopressor as tolerable
with blood pressure. We will continue to trend INR and give vitamin K as needed.
Obtain an echo due to weakness and fatigue. Her last echo was in 2013, and we will
continue to follow the case.
ABRAM BASINGER
D: **/**/**** 9:15:33 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22821210
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: The patient is an 80-year-old male who presented to
the emergency department with chest pain. Chest pain started after church. Chest
pain is over the center of his chest and radiated over to the left side. He was
recently seen in the office on **/**/****, for complaints of chest pain and it has
been going on from the previous week. He does admit to having shortness of breath
and a cough with this. He does have a history of COPD, nonproductive cough. In
the emergency department, his temperature was 100.0. He does admit to having
chills before coming into the emergency department. Last echo was on **/**/****,
it showed EF of 46%, concentric left ventricular hypertrophy, normal LVEDP, RV
systolic function normal, right ventricular enlargement, mild-to-moderate aortic
stenosis, mean gradient of 19, dilated ascending aorta of 4.1 cm, mild-to-moderate
aortic regurgitation, severe mitral annular calcification. Last heart cath was
done in 02/2021, left main distal 90% stenosis. Left circumflex diffuse 80%
stenosis, small vessel, LAD proximal 100%, RCA mid 80 to 0% with stent placement,
PDA small vessel 90%, PLB-1 ____ and PLB-2 _____ were both ballooned, PLB-3 had
mild disease, LIMA to LAD was patent, SVG to OM had stent placement.
PAST MEDICAL HISTORY: He has a previous medical history of hyperlipidemia,
insomnia, PPD, GERD, CABG in 2000, hiatal hernia, sinus congestion, cough, gout,
CAD, rheumatoid arthritis, hypertension, COPD, type 2 diabetes, and CLL.
PAST SURGICAL HISTORY: He has a previous surgical history of CABG x4, coronary
angioplasty requiring stent in the past, hiatal hernia repair, bilateral cataracts,
pacemaker insertion.
FAMILY HISTORY: He has a family history of mother having heart disease, sister
having heart disease, and brother having heart disease.
SOCIAL HISTORY: He is a former smoker. He does not use any alcohol. Does not use
any illicit drugs.
ALLERGIES: He has allergies to LIPITOR, FENOFIBRATE, GABAPENTIN, PRAVASTATIN, and
PNEUMOCOCCAL VACCINE.
HOME MEDICATIONS: He is on Lyrica, Xanax, Norco, Lasix, Plavix, Zanaflex,
glipizide, Crestor, Lopressor, Cozaar, albuterol, metformin, Bumex, Eliquis, folic
acid, Mucinex, Nexium, and baby aspirin.
any acute distress.
VITAL SIGNS: The patient's temperature 100.8, respiratory rate is 24, pulse is at
97, blood pressure 132/70, oxygen saturation 93% on room air.
light. Hard of hearing.
LUNGS: Diminished lung bases. No wheezes or rhonchi is noted. Positive
nonproductive cough.
HEART: Heart rate and rhythm regular.
ABDOMEN: Soft and nontender. Bowel sounds are present. No hepatosplenomegaly.
No guarding noted.
LABORATORY DATA: White blood cell count is 18.8. Lactic acid is elevated at 22.
Potassium 4.5. Creatinine is at 1.1. Troponin negative. ProBNP 546.
DIAGNOSTIC STUDIES: Chest x-ray, impression nonspecific pulmonary infiltrates can
be seen with atypical/viral pneumonia.
Congestive heart failure is a consideration as well given radiographic findings.
Calcific atherosclerosis of aorta. Cardiomegaly.
IMPRESSION: This is an 80-year-old male who presented to the emergency department
for chest pain, and found to be febrile with temperature of 100.8. White blood
cell count is at 18.8. Chest x-ray suggestive of pneumonia. Antibiotics started
by ER doctor. He has a strong previous medical history of CAD, needing stents and
a CABG in the past. We will continue to trend troponin at this time. EKG
reviewed, no ST segment changes in the emergency department. Baseline monitor.
Just had stress test done in August. We will continue to watch infection is
cleared and see if chest pain is still present. We will continue to trend
troponin.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22810396
CONSULTATION
CONSULTATION
***************
INDICATION: A 2:1 heart block.
HISTORY OF PRESENT ILLNESS: This is an 87-year-old male who presented to the
emergency department after his cardiologist have an abnormal heart rate reading.
His cardiologist is Dr. Kabir. When he arrived to the emergency department, he was
found to have 2:1 heart block, heart rate of 40 at that time. Overall, he was
feeling bad during that time. He was watching television _____ and was having
blurry vision. He was seen at _____ Hospital in 2020 for a six-second pause on
Holter. Beta-blocker was stopped at that time. When he came and admitted to the
emergency department, potassium was elevated at 6.7, creatinine was at 1.9.
Troponins are negative as well. Last echo in 2016 showed mild left ventricular
hypertrophy, left ventricular function preserved at 50%, mild left enlargement
noted, grade 1 diastolic dysfunction, mild aortic stenosis present, mild mitral and
tricuspid valve regurgitation noted.
PAST MEDICAL HISTORY: Hypertension, pancreatitis, pneumonia, COPD, CAD,
respiratory arrest, diabetes, skin cancer, and CVA.
PAST SURGICAL HISTORY: Skin biopsy, colonoscopy, cardiac catheterization, and
cholecystectomy.
SOCIAL HISTORY: Former smoker. Does not use any alcohol and he does not use any
illicit drug use.
FAMILY HISTORY: Mom had heart disease.
ALLERGIES: He has allergies to AUGMENTIN, PENICILLIN, and MUCINEX.
HOME MEDICATIONS: He is on albuterol, amlodipine, aspirin, hydralazine,
lisinopril, Claritin, metformin, Flomax, Maxzide.
any acute distress.
VITAL SIGNS: Afebrile at 98 degrees, respirations are at 16, pulse is at 77, blood
pressure 124/58, and saturating 95% on room air.
ABDOMEN: Soft and nontender. Bowel sounds are present. No hepatosplenomegaly or
guarding noted.
LABORATORY DATA: Potassium is 5.5, creatinine is down to 1.6. Troponin have been
negative.
DIAGNOSTIC RESULTS: CT of the head showed no acute intracranial abnormalities.
Some changes in sequela of prior stroke including left frontoparietal region.
Chest x-ray showed no acute processes.
IMPRESSION: This is an 87-year-old male who presented to the ER with abnormal
Holter monitor reading and found to be in 2:1 heart block at that time. Currently
seems to be off any beta-blockers due to dizziness. Heart rate this morning is in
the 70s to 80s. We will continue to monitor heart rate. Last echo in 2016, we
will get new echo to look out heart function. Hypokalemic also on admission,
Nephrology is following. New potassium is down to 5.5. Overall feeling better
than when coming into the emergency department. His fatigue and blurred vision
have resolved. We will continue to monitor heart rate since off beta-blockers and
having episodes of heart block. We will discuss need for pacemaker.
ABRAM BASINGER
D: **/**/**** 8:59:31 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22810205
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Near syncope.
emergency department yesterday with a near syncopal episode. He states he was
cleaning his car. During this time, he felt like he was going to pass out. He was
seen last month, 08/13 for a syncopal episode at the hospital. He denies any chest
pain or palpitations. States that he has multiple dizziness episodes throughout
the day, majority of them when going from the sitting to standing position.
Recently in the office, he just wore his Zio monitor for seven days, minimum heart
rate on monitor was 52 beats per minute, average heart rate was at 68, max heart
rate was at 96. The patient had one episode of nonsustained VT for 4 beats, and he
had frequent PVC burden with burden percentage at 21.9 percent. He also has had
echo done in 06/2021, left ventricle systolic function is normal, EF was 50% to
55%, mild left ventricular hypertrophy, jugular vein regurgitation. No evidence of
any pericardial effusion. Last heart cath was on **/**/****. At that time, left
main was patent, LAD was mid 100% occluded was unchanged. Circ proximally stented
has in-stent stenosis at 80%, gave off down branch. RCA is approximately 100%
occluded. There is a right-to-right collateral and left-to-right collateral
circulation. SVG to OM branch was slightly patent. LIMA to LAD is patent. At
that time, they attempted an angioplasty to proximal circ lesion for in-stent
stenosis.
PAST MEDICAL HISTORY: He has a previous medical history of diabetes, CAD,
hypertension, arthritis, GERD, chronic kidney disease, carotid artery disease.
Last checked on his last admission, left RCA was 50% to 60% occluded. No
hemodynamic stenosis on the right RCA. Hyperlipidemia acute, PE, excessive daytime
sleepiness and snoring.
PAST SURGICAL HISTORY: He has a previous surgical history of CABG, coronary
angioplasty with stent placement, tonsillectomy, and eye surgery.
SOCIAL HISTORY: Never smoked. Does not use any alcohol. Does not use any illicit
drugs.
FAMILY HISTORY: Father with heart disease. Mother with diabetes, high blood
pressure, and CVA. Sister with diabetes and CVA.
ALLERGIES: He has allergies to DOXYCYCLINE.
HOME MEDICATIONS: Amiodarone, Coreg, Eliquis, Flomax, isosorbide, potassium,
Lasix, Levemir, Lipitor, losartan, mag ox, metolazone, Synthroid.
any acute distress.
VITAL SIGNS: The patient is afebrile, 97.5. Respiratory rate at 14, pulse is at
60, blood pressure 150/74, oxygen levels are at 100% on room air.
ABDOMEN: Soft, nontender. Bowel sounds are present. No hepatosplenomegaly or
guarding noted.
EXTREMITIES: No cyanosis or clubbing noted. Nonpitting edema and discoloration
noted.
LABORATORY DATA: Baseline troponin 0.023, repeat this morning is 0.039. ProBNP
1213. Potassium 3.8. Creatinine 1.7. Magnesium 1.9. Glucose on admission is
407. TSH is at 7.4.
DIAGNOSTIC TESTING: CT of the head showed no acute intracranial abnormalities.
Chest x-ray showed nonspecific local opacities in medial lung lobe, lower right
lung and lateral left lower lung. COVID-19 in lung is consideration, all those
findings could simply be related to subsegmental atelectasis. COVID-19 test is
negative. Calcification, calcific atherosclerosis aorta and cardiomegaly.
IMPRESSION: This is an 88-year-old male who presented to the emergency department
with near syncope and dizziness. He had a syncopal episode last month. He was
seen in the office recently and had monitor worn. No pauses or significant
arrhythmias noted at that time. They defined high PVC burden. Troponin elevated.
He does have recent fall where he hit his chest, musculoskeletal pain on the chest.
Denies any shortness of breath with it. He does have a history of CAD, in-stent
stenosis, and CABG in the past. We will get stress test to rule out any CAD.
Continue to monitor blood pressure and heart rate. I will also check for
orthostatics.
ABRAM BASINGER
D: **/**/**** 8:42:11 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22810198
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: This is a 38-year-old female who was admitted for
chest pain. Chest pain has been midsternal and radiates into the back. Chest pain
began yesterday afternoon after exerting herself while playing with her child. She
has had chest pain before most recently within the emergency room on 08/30, very
similar pain. When she came in, troponin were elevated to 0.128. Repeat troponin
0.127. She has history of muscular dystrophy and is wheelchair bound. When she
was having chest pain, she felt flushed and diaphoretic and some nausea was also
present at that time.
Last echo on **/**/**** showed left ventricular systolic function, normal EF of 50%
to 55%. No significant valvular disease. No evidence of any pericardial effusion.
False tendon noted in the left ventricle diastolic function is preserved.
PAST MEDICAL HISTORY: She has a previous medical history of muscular dystrophy,
migraine, herniated disc, bronchitis, anxiety, seizures, and chest pain.
PAST SURGICAL HISTORY: She has a previous surgical history of hernia repair,
cesarean section, tubal ligation, and cholecystectomy.
SOCIAL HISTORY: Former smoker. Occasional alcohol use. Occasional marijuana use.
FAMILY HISTORY: Mother has a history of CVA. Father has a history of muscular
dystrophy.
ALLERGIES: She has allergies to BUSPIRONE, CYMBALTA, TRAZODONE, and VICODIN.
HOME MEDICATIONS: She is on Klonopin and baby aspirin.
any acute distress.
VITAL SIGNS: Afebrile, 97.8. Respirations are 16, pulse is at 83, blood pressure
116/69, saturating at 100% on room air.
light.
guarding noted.
LABORATORY DATA: Troponin is 0.127, potassium 3.4, creatinine is less than 0.5.
Total CK 4687. Hemoglobin is at 12.3.
IMPRESSION: This is a 38-year-old female who presents into the emergency
department with chest pain. She has had recurrent chest pain in the past, most
recently at the end of August. She has a history of muscular dystrophy. New onset
of chest pain, midsternal, radiates into the back. Troponin is elevated. We will
get echo, has history of mitral valve prolapse. We will consider doing heart cath
on this admission due to recurring emergency room trips with chest pain and
elevated troponin.
ABRAM BASINGER
D: **/**/**** 8:21:59 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22810191
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Pericardial window, chest pain.
HISTORY OF PRESENT ILLNESS: This is a 46-year-old female who presented with a
chest discomfort, found to have pericardial effusion. She was taken back for
pericardial window, 300 mL was removed, pericardial tissue was sent to Pathology.
The patient just have symptoms that have been going on for four days of chest
discomfort, shortness of breath, and dizziness. The patient just had Roux-En-Y
revision at an outside hospital, and symptoms have been presenting ever since then.
The patient has also history of permanent pacemaker insertion with Dr. Gujja for
complete heart block and syncope. Echo was completed on **/**/**** showed EF of
60%, moderate-to-large pericardial effusion loculated along the left anterolateral
wall. There is a sign of cardiac tamponade with echo.
PAST MEDICAL HISTORY: Anxiety, hypothyroid, seizures, syncope, thyroid disease and
vertigo.
PAST SURGICAL HISTORY: Gastric bypass, cholecystectomy, cesarean section, and
pacemaker insertion.
GENERAL: The patient is awake and alert, answering all questions appropriately,
not in any acute distress.
VITAL SIGNS: Afebrile, 97.8. Respiratory rate at 18. Pulse is at 105. Blood
pressure 95/60. Satting at 100% on 3 liters nasal cannula.
CHEST: Equal in expansion. Pericardial window site clean, dry, and intact.
LUNGS: Clear to auscultation. No wheezes or rhonchi are noted.
guarding noted.
EXTREMITIES: No cyanosis or clubbing noted. No edema.
LABORATORY DATA: Creatinine 0.6. Potassium 4.5. Troponin is negative. ProBNP
137. Hemoglobin 11.8.
No radiology data.
with chest pain, shortness of breath, dizziness, found to have pericardial effusion
with tamponade. Pericardial window was performed yesterday with CT surgery, 300 mL
were removed at that time. Dressing looks clean, dry, and intact. She is overall
feeling better today. This all happened after Roux-En-Y revision could have been
contributing to pericardial effusion. We will continue to monitor heart rate and
blood pressure. Blood pressure remained hypertensive stable.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22809897
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Shortness of breath, lower extremity edema.
HISTORY OF PRESENT ILLNESS: This is a 76-year-old female who came into the
emergency department after worsening shortness of breath. The shortness of breath
has been getting progressively worse over the last four days. The patient states
that she cannot ambulate anymore without getting extreme shortness of breath when
exerting herself. In the emergency department, IV has been given to her. She is
also noticing increased lower extremity edema that has been progressive over the
last four days as well. She has a dry cough. Denies any fever or chills. Denies
any wheezing. She does have a history of COPD. She complains of no chest pain or
dizziness. She had an echo done in 12/2020, which showed EF was estimated at 65%,
moderate left ventricular hypertrophy, moderate dilated left atrium, mitral valve
annular calcification, mild mitral stenosis mean gradient was 6 mmHg.
PAST MEDICAL HISTORY: She has a history of atrial fibrillation, on
anticoagulation; history of skin cancer; history of carpal tunnel; history of COPD;
history of diabetes; hyperlipidemia; hypertension; and sleep apnea, uses CPAP at
home.
PAST SURGICAL HISTORY: She had a previous surgical history of carpal tunnel
release, colonoscopy, endoscopy, hysterectomy, tonsillectomy, EGD.
FAMILY HISTORY: Mother and father having heart disease. Father having cancer.
SOCIAL HISTORY: No tobacco or smoking history. Does not use any alcohol. No
illicit drug use.
ALLERGIES: She has allergies to CODEINE and SULFA antibiotics.
HOME MEDICATIONS: Pulmicort, Toprol-XL, Lasix, Reglan, Cymbalta, THEO-24,
hydralazine, Nexium, TriCor, Topamax, Lipitor, BuSpar, Brovana, Tresiba, metformin,
Xarelto, insulin aspart, Amitiza.
GENERAL: This patient is awake and alert, answering questions appropriately,
slightly shortness of breath when answering questions.
VITAL SIGNS: The patient is afebrile, 98.3. Respirations are 22. Pulse is at
106. Blood pressure 154/84. She is satting at 99% on nasal cannula.
LUNGS: Crackles heard in bases of lungs. No wheezes or rhonchi noted.
HEART: Regular rate and rhythm. Tachycardic.
ABDOMEN: Soft. Nontender. Bowel sounds present. No hepatosplenomegaly or
guarding noted.
EXTREMITIES: No cyanosis or clubbing noted. A 1+ lower extremity edema.
LABORATORY DATA: Troponin have been negative. ProBNP elevated at 1186. Potassium
4.5. Creatinine 0.7. Hemoglobin 10.1.
CTA pulmonary showed no evidence of pulmonary embolism, borderline cardiomegaly,
trace bilateral pleural effusion, marked, mosaic, attenuated throughout the
bilateral lungs
suggestive of small airway disease or myocardial perfusion abnormality.
IMPRESSION: This is a 76-year-old female who presented to the emergency room for
increasing shortness of breath and lower extremity swelling, which has been going
on over the last four days. We will continue to treat with IV diuretics. Overall
feeling better this morning. States that edema has also been getting better, down
to 1+ lower extremity edema. We will obtain echocardiogram to look out heart
function. We will increase metoprolol due to blood pressure and heart rate being
elevated. No history of COPD, but no wheezing noted. Troponin have been negative.
ProBNP is elevated. Continue diuresing.
ABRAM BASINGER
D: **/**/**** 8:42:38 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22809829
CC:
CONSULTATION
CONSULTATION
***************
REASON FOR CONSULT: Syncope.
HISTORY OF PRESENT ILLNESS: This is an 86-year-old female who was brought to the
emergency department by EMS for syncope. She was at her veterans office waiting
out in the sun when this episode happened. She had no history of syncope in the
past. She does have a permanent pacemaker for heart block, dual chamber BiV ICD.
She denies any sort of seizure activity. She is unclear on how long she was out.
No trauma during the syncopal episode. Prior to this episode, the patient has been
feeling increased fatigue at home, complaining of fatigue and slight chest
pressure. No complaints of any nausea or vomiting. No complaints of any sort of
dizziness prior, have been increased in number of falls at home due to weakness and
fatigue, but not due to dizziness or syncope.
Last echo showed EF 54%, concentric left ventricular hypertrophy, mild-to-moderate
mitral regurgitation, mild aortic regurgitation. Last stress test in 2020 showed
mild reversible outer wall myocardial ischemia, artifact decreased sensitivity of
this, and now jeopardized myocardium is very small. No intervention was done at
that time.
PAST MEDICAL HISTORY: The patient has prior medical history of AFib, not on any
anticoagulation due to intolerance and frequent falls. Arthritis, CAD,
fibromyalgia, GERD, thyroid, gastric ulcers.
PAST SURGICAL HISTORY: Appendectomy, bladder surgery, cholecystectomy, eye
surgery, hysterectomy, pacemaker insertion, BiV pacemaker Medtronic.
SOCIAL HISTORY: Former smoker. Does not use any alcohol. Does not use any
illicit drugs.
FAMILY HISTORY: She has family history of hypertension on her mother and father
side.
ALLERGIES: Allergies to AMITRIPTYLINE, ASPIRIN, CODEINE, IBUPROFEN, PLAQUENIL,
THEOPHYLLINE.
HOME MEDICATIONS: Cymbalta, Synthroid, Lopressor, albuterol, Flonase.
any acute distress.
VITAL SIGNS: Hypertensive, blood pressure 192/109. Pulse of 72, 80 paced.
Respirations are 18. Afebrile, 98.2. Satting 94% on room air.
HEENT: Head is normocephalic, atraumatic. Pupils equal and reactive to light.
LUNGS: Clear to auscultation. No wheezes or rhonchi are noted.
guarding noted.
LABORATORY DATA: Troponin have all been negative. ProBNP elevated at 1158.
Potassium 3.5. Creatinine is at 1. Hemoglobin is at 12.0. D-dimer is 275.
CTA of the chest showed no pulmonary embolism. CT of the head showed no acute
intracranial abnormalities. CT of the cervical spine showed no acute abnormalities
of the cervical spine.
IMPRESSION: This is an 86-year-old female who presents for syncopal episode with a
history of BiV pacemaker. We will interrogate pacemaker. Has history of AFib. We
will also check echo to look out LV function. We will get ultrasound of carotid
for a syncopal workup. She is very hypertensive. We will add Norvasc to help with
hypertension. Troponin have all been negative. She does complain of on and off
chest pressure over the last several weeks and fatigue. We may look out doing
stress test in the future. We will talk to her again about starting
anticoagulation for AFib.
ABRAM BASINGER
D: **/**/**** 8:23:14 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22809826
CC:
CONSULTATION
CONSULTATION
***************
INDICATIONS: PVCs.
HISTORY OF PRESENT ILLNESS: This is a 60-year-old male who presented to the
emergency department for abdominal spasms that had been going on since Wednesday.
By Saturday, he started having nausea and vomiting with distension in the abdomen,
poor appetite. Last bowel movement was on Thursday. He was brought on in and CTA
was done, which showed small bowel obstruction with free air and intra-abdominal
fluid. He had emergent abdominal exploration surgery yesterday and appendectomy
yesterday as well. Today, postop day 1, recovering, seen on telemetry to have
increased PVCs. This is new. Talking with the patient, he has had extra heart
beats for a while according to his PCP. He has not followed with any cardiologist
in the past. Also having tachycardia as well. EKG yesterday showed sinus rhythm,
heart rate 99.
PAST MEDICAL HISTORY: He has no past medical history.
SURGICAL HISTORY: Hernia repair.
SOCIAL HISTORY: Smokes one pack a day. Uses alcohol occasionally. Does not use
of any illicit drugs.
FAMILY HISTORY: No CAD in the immediate family.
HOME MEDICATIONS: He is on Bentyl, Zofran, Pepcid, Carafate, and Atarax.
GENERAL: He is awake and alert, not in any acute distress, answering questions
appropriately.
VITAL SIGNS: Afebrile. Respiratory rate at 27. Pulse is at 134. Blood pressure
113/88. Oxygen level is at 92 on 2 liters nasal cannula.
HEENT: Head is normocephalic, atraumatic. Pupils equal and reactive to light.
LUNGS: Clear to auscultation. No wheezes or rhonchi are present.
ABDOMEN: Dressing present on abdomen, not saturated. Bowel sounds are present.
LABORATORY DATA: Potassium 4.7, creatinine 0.7. Hemoglobin 15.3. Troponins were
negative.
IMPRESSION: This is a 60-year-old male who came in to the emergency room for
abdominal discomfort that needed emergent exploratory laparotomy and appendectomy.
He has been seen today for increased PVC burden. Per the patient, he does have a
history of having extra beats. Per PCP, he does not take anything for it. Given
increase in PVCs and elevated heart rate, we will start him on Lopressor 50 mg
b.i.d. We will also get echo to see if the PVCs have affected the heart function
at all. We will continue to trend heart rate, blood pressure, and PVC burden, and
we will watch for echo results.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22763342
CC:
CONSULTATION
CONSULTATION
***************
INDICATIONS: Cardiac clearance.
emergency department with continuous concerns about hyperglycemia and fatigue that
had been getting progressively worse over the last two weeks. At the end of it,
she was unable to walk far distances without feeling that her legs were going to
give out. Recently diagnosed with hyperglycemia. The last blood glucose was 179.
She has been having difficulty lifting her legs, needing to use her arms to assist
them to get them off the bed. Follows with Dr. Woods. Dr. Woods is planning on
surgery here soon. Cardiac history-wise, she has no previous cardiac history. She
has never seen a cardiologist or followed up with a cardiologist.
FAMILY HISTORY: Her father and sister have hypertension, but no CAD noted in the
family. Declines any chest pain or shortness of breath. Declines any
palpitations, edema or dizziness.
PAST MEDICAL HISTORY: She has a previous medical history of diabetes, kidney
stones, basal cell carcinoma of the nose, thyroid disease, and hypertension.
appendectomy, lithotripsy, and tubal ligation.
SOCIAL HISTORY: She has never smoked. No alcohol or drug use.
ALLERGIES: She has allergies to DARVON, DEMEROL, and DILAUDID.
HOME MEDICATIONS: She is on gabapentin, Dacogen, Maxzide, Synthroid.
any acute distress.
VITAL SIGNS: Temperature 100.2, respirations are 18, pulse is at 89, blood
pressure 107/49, and she is saturating 98% on room air.
guarding noted.
LABORATORY DATA: Potassium is at 2.6. She is getting IV potassium replacement
right now. Hemoglobin 14.3, white blood cells 4.7. Last blood glucose is 179.
She had a chest x-ray yesterday, result showed clear lungs, no acute
cardiopulmonary abnormalities. EKG showed sinus tachycardia rhythm at 101.
IMPRESSION: This is a 63-year-old female with history of uncontrolled diabetes,
hypertension, who came to the hospital for increasing weakness. Planning on
upcoming surgery on back. From a cardiac standpoint, echocardiogram has been done
this morning, no extensive cardiac history. EKG is reviewed. From a cardiac
standpoint, okay to proceed with procedure, would be low cardiac risk at this time.
We will continue to follow results of the echocardiogram. Continue to follow
potassium levels as well.
ABRAM BASINGER
D: **/**/**** 9:29:35 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22762960
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Chest pain and shortness of breath.
emergency department for shortness of breath. Shortness of breath had been
increasingly worse. She has a history of COPD, but she was unable to walk any
distances out, becoming short of breath. This morning, she also felt to experience
chest discomfort. Chest discomfort is midsternal, radiates into the back. This
happens when she takes a deep breath and when she switches position. Troponin last
night was negative. EKG reviewed from the emergency department. She has had no
cardiac workup in the past other than echo in 2015, did not follow with a
Cardiology. Last echo in 2015 showed EF of 60%, normal LD, mild MR and TR, mild
aortic insufficiency.
PAST MEDICAL HISTORY: She has a previous medical history of lupus, COPD,
thrombocytopenia, hydronephritis, and Hodgkin's lymphoma in remission.
thyroidectomy, and hip and elbow replacement.
SOCIAL HISTORY: Former smoker. Does not use any alcohol. Does not use any
illicit drugs.
FAMILY HISTORY: No CAD in family history.
ALLERGIES: She has allergies to DARVOCET, SHAKES, IODINE, MAPLE FLAVORING, and
DARVON.
HOME MEDICATIONS: Albuterol, Mucinex, Mobic, prednisone, Plaquenil, and Atrovent.
any acute distress.
VITAL SIGNS: The patient is afebrile at 98.2. Respirations are 18, pulse is at
77, blood pressure 153/81, she is saturating at 96% on room air.
light.
guarding noted.
LABORATORY DATA: Troponins have been negative. Potassium 4.1, creatinine 0.6.
Hemoglobin 13. Negative D-dimer. COVID-19 not detected.
IMPRESSION: This is a 77-year-old female who presents with shortness of breath and
chest pain that is atypical with inspiration. Pain occurs with inspiration and
with some movement, very reproducible. We will get echo at this point. Does have
a history per the patient of pericardial effusion. We will get repeat troponin to
trend troponin to make sure that they are not becoming elevated. Given atypical
chest pain being reproducible, we will not get stress test at this time. We will
continue to follow laboratory data and vital signs.
ABRAM BASINGER
D: **/**/**** 9:02:12 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22762893
CC:
CONSULTATION
CONSULTATION
***************
***************
INDICATIONS: Shortness of breath and edema.
hospital with increasing shortness of breath and edema that had been going on over
the last two days. Yesterday, she experienced an episode of chest pain, which got
her more concerned and which made her wanted to come to the hospital. She has a
history of acute-on-chronic heart failure with a preserved EF, on Lasix at home,
but she just noticed that the edema was getting worse and worse and increasing
shortness of breath. Down in the ER, I gave IV Lasix and metolazone, and swelling
has improved since then. Today, she says that she is feeling better. No chest
pain. Troponins have all been negative. Her last echocardiogram showed left
ventricular systolic function is normal. Ejection fraction is visually estimated
at 55%, mild tricuspid regurg, RVSP 27 mmHg. No evidence of any pericardial
effusion. Technically difficult study due to poor body habitus.
PAST MEDICAL HISTORY: She has a previous medical history of hypertension, CHF,
COPD, anxiety, depression, hyperlipidemia, chronic back pain, arthritis, panic
attack spells, history of blood clots, and history of DVT.
PAST SURGICAL HISTORY: Has a previous surgical history of right shoulder surgery,
hysterectomy, tonsillectomy, left total knee.
FAMILY HISTORY: Mother had a history of hypertension, hyperlipidemia.
SOCIAL HISTORY: She is a former smoker. Denied use of any alcohol or any illicit
drugs.
HOME MEDICATIONS: She is on Nexium, gabapentin, Linzess, Robaxin, Zaroxolyn,
potassium, Ranexa, Eliquis, Lasix, Lipitor, Colace, oxybutynin, vitamin D,
Cymbalta, Xanax, hydrocodone, acetaminophen, Prilosec, DuoNeb, and albuterol
inhaler.
ALLERGIES: She has allergies to MORPHINE, CODEINE, ADHESIVE TAPE, and ZANAFLEX.
GENERAL: Awake and alert, not in any acute distress, answering questions
appropriately.
VITAL SIGNS: Afebrile, respirations are 18, she is saturating at 97% on 2 L, pulse
is at 66, blood pressure 131/79.
light.
ABDOMEN: Soft and nontender. Bowel sounds are present. No hepatosplenomegaly
noted. No guarding noted.
EXTREMITIES: No cyanosis or clubbing noted; 2+ lower extremity edema.
LABORATORY DATA: Troponins have all been negative. Potassium at 4.2, creatinine
at 1.1. GFR of 58. Magnesium at 2.1. ProBNP on admission was 309. Hemoglobin
12.0.
IMPRESSION AND PLAN: This is a 79-year-old female who presented to the hospital
with CHF exacerbation. We will continue with IV diuretics. Has a history of CKD.
Nephrology will be the one handling diuretics. Today, she declines any further
chest pain or shortness of breath. Troponins have all been negative. We could not
get a stress test at this time. Last stress test was done last March. No ischemia
was noted at that time. Continue with diuretics. Continue to watch the
electrolytes. Echo is being completed this a.m. This plan was discussed with Dr.
Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 8:26:05 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22762820
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Valvular heart disease.
HISTORY OF PRESENT ILLNESS: This is an 85-year-old female who presents to the
hospital after a followup blood work with Dr. Charles' office. She was found to be
severely anemic. Hemoglobin was at 5.9 when coming into the hospital. She
received two units of packed red blood cells. Today, hemoglobin is up to 8.4. She
was admitted a month ago for anemia as well. EGD at that time was negative. She
has a history of moderate to severe mitral regurgitation. In the last hospital
visit, she was going to have a TEE and a right and left heart cath to better
evaluate the mitral valve. Unfortunately, due to anemia, we were unable to at that
time. Her last echo was on **/**/****, EF was 70% at that time, moderate aortic
stenosis, mild pulmonary hypertension, mild aortic regurge. Aortic valve mean
gradient was 25 mmHg. Mitral valve mean gradient was 5 mmHg. Chordal systolic
anterior motion was at peak. Left ventricle was at peak. LVOT gradient of 34.54,
moderate to severe mitral regurge was found on the echo as well.
PAST MEDICAL HISTORY: She had a past medical history of PAF, hypertension,
hyperlipidemia, history of breast cancer, history of ovarian cancer, and anemia.
PAST SURGICAL HISTORY: She had a previous surgical history of a left mastectomy,
hysterectomy, head surgery, shoulder surgery, and cholecystectomy.
SOCIAL HISTORY: She denies smoking. Denies any alcohol use. Denies any illicit
drug use.
FAMILY HISTORY: No known heart disease.
HOME MEDICATIONS: Amiodarone 100 mg daily, Crestor, ferrous sulfate, Fosamax,
lisinopril/hydrochlorothiazide, Losec, Norvasc, Prilosec, Ambien, BuSpar, and iron
supplement.
any acute distress.
VITAL SIGNS: The patient is afebrile, respiratory rate at 18, pulse is at 86,
blood pressure 112/53, oxygen sat 94% on room air.
LUNGS: Clear to auscultation. No wheezes or rhonchi at present.
guarding noted.
LABORATORY DATA: Hemoglobin today is 8.4, up from 5.9 yesterday.
IMPRESSION: This is an 85-year-old female who presented with anemia. She needs
TEE and right and left heart cath to better evaluate mitral valve. We will
continue to hold off at this time until the anemia is corrected. She has a history
of PAF. Continue off anticoagulation due to anemia. She has no overt bleeding.
She denies any blood in the stool, black or tarry stool, denies any coffee-ground
emesis. We will continue to look at workup for anemia. At this time, we will
monitor her on telemetry and continue to monitor her condition. This plan was
ABRAM BASINGER
D: **/**/**** 7:56:13 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22762792
CC:
CONSULTATION
CONSULTATION
***************
INDICATIONS: Chest pain and bradycardia.
hospital yesterday with chest pain that has onset about two hours before coming in.
The chest pain came when he was helping in putting a fence up. Chest pain was
midsternal, about 6/10. It was a dull pain. He took one nitroglycerin tablet and
chest pain subsided. Also, overnight he had an episode of 3.6-second pause on
telemetry. Pause happened around 11:45 at night. The patient was unaware. When
coming in to the emergency department, he was having bradycardia. Coreg was
stopped at that time. The patient also has a history of sleep apnea and does not
use a CPAP.
The patient has a history of CABG x3 in the past. LIMA to diagonal and LAD,
sequential graft SVT to the OM.
PREVIOUS MEDICAL HISTORY: Hypertension, hyperlipidemia, CAD, anemia, GERD, OSA,
BPH.
SURGICAL HISTORY: Cholecystectomy, prostate surgery, CABG.
SOCIAL HISTORY: He was a former smoker. Drinks about 9 cans of beer a week. Does
not use any illicit drugs.
FAMILY HISTORY: Mother and father are both hypertensive, hyperlipidemia.
ALLERGIES: He is allergic to NIACIN, ZOCOR, and _____.
HOME MEDICATIONS: He is on doxazosin, omeprazole, lisinopril, baby aspirin,
metoprolol 25, fish oil, and pravastatin.
any acute distress.
VITAL SIGNS: The patient is afebrile at 97.8, respirations are 18, pulse is at 81,
BP 122/71, and saturating 100% on 2 liters nasal cannula.
LUNGS: Clear to auscultation. No wheezes or rhonchi is present.
guarding noted.
LABORATORY DATA: Troponin series have been negative. Creatinine is at 1.4,
potassium 4.1. Hemoglobin 12.3. Chest x-ray yesterday showed cardiomegaly with
pulmonary vascular congestion. No overt edema or consolidation. EKG this morning
showed normal sinus rhythm. Heart rate at 70.
IMPRESSION: This is an 80-year-old male who presented to the hospital with chest
pain and bradycardia. Chest pain has resolved. He does have a history of CAD with
CABG x3 back in 2012. We will get echocardiogram this a.m. Bradycardia with a
3.6-second pause at night. Continue to hold beta blockers. Continue to monitor
heart rate. This could be sleep apnea related. He has a history of sleep apnea,
but does not wear CPAP. I talked to him about the importance of using _____ CPAP
at night. Troponins negative. Chest pain went away. I do not believe this is
ACS. We will continue to follow and look for the results of the echo.
ABRAM BASINGER
D: **/**/**** 7:53:57 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22760678
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: This is a 75-year-old female who presented today to
Emergency department for chest pain. Chest pain started about an hour from when
the EMS arrived. Chest pain felt like heaviness on the chest, shortness of breath,
as well as associated with the pain and radiated into the neck. Yesterday, she was
having shoulder pain as well before this, and EMS took her to the Emergency
Department. Nitroglycerin was given to her en route and this helped reduce her
chest heaviness. Chest pain was not during exertion, when she was just going from
sitting to standing position. She has not had any episodes ever since being to the
Emergency Department.
PAST MEDICAL HISTORY:
1. CAD with a stent to the mid LAD in 2014.
2. She has a history of PAF.
3. Hypertension.
4. Hyperlipidemia.
5. Asthma.
6. Diabetes.
7. Arthritis.
8. Thyroid.
PAST SURGICAL HISTORY:
1. Appendectomy.
2. Tonsillectomy
3. Hysterectomy
4. Tubal ligation.
5. Cholecystectomy.
6. Left shoulder surgery.
7. Left elbow surgery.
8. Total knee arthroplasty.
SOCIAL HISTORY: She has never smoked. She does not smoke, drink, or use any
illicit drugs.
FAMILY HISTORY: No known CAD in the family.
ALLERGIES: To MORPHINE, TAPE, and SEASONAL ALLERGIES.
MEDICATIONS: She is on,
1. Advair inhaler
2. Full-dose aspirin.
3. Celexa.
4. Folic acid.
5. Glucophage
6. Lisinopril.
7. Hydrochlorothiazide.
8. Meclizine.
9. Metoprolol succinate.
10. Omega-3.
11. Singulair.
12. Synthroid.
GENERAL: The patient awake, alert, answering questions appropriately, not in any
acute distress.
VITAL SIGNS: Afebrile, temperature 98.5, respirations are 18, pulse 83, blood
pressure 117/66, and she is satting at 97% on room air.
light.
ABDOMEN: Soft and nontender. Bowel sounds are present. No hepatosplenomegaly
noted.
EXTREMITIES: No cyanosis or clubbing or edema noted.
LABORATORY DATA: Troponins have been negative. ProBNP is at 20. Potassium is at
4.1. Creatinine is 0.6. White blood cell count is at 16.7.
IMPRESSION: This is a 75-year-old female who presented to the Emergency Department
with new onset of chest pain. Chest pain has been relieved with nitroglycerin; a
dull pain is still present. This pain is very similar to the pain that she had
back in 2014 before her stent was placed. We will do cardiac workup and get an
echo and have her do stress test. We will continue to monitor troponin and
continue other labs, and we will make recommendations based on the findings.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22749822
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Atrial fibrillation.
HISTORY OF PRESENT ILLNESS: This is an 82-year-old female who originally presented
to the emergency department with feelings of heart racing, palpitations,
generalized fatigue, and dizziness. She called the EMS where her heart rate was in
between 120s and 140s. At that time, she had difficulty speaking and weakness in
her extremities. She then converted back to normal sinus rhythm before EKG was
able to get done. Did a CT of the head due to the difficulty speaking and weakness
in the extremities and found 1.5 x 2.5 x 3.1 mm saccular aneurysm in the left
internal carotid artery. She has not had this experience before. She denies any
sort of chest pain, shortness of breath. She has not had no cardiac workup done
before this.
PAST MEDICAL HISTORY: Back pain and questionable PAF.
SOCIAL HISTORY: She does not smoke. She does not drink. She does not use any
illicit drugs.
FAMILY HISTORY: Her family history is unknown to her.
ALLERGIES: She is allergic to DEMEROL, CODEINE, and IBUPROFEN.
HOME MEDICATIONS: She is on lisinopril, hydrochlorothiazide, amlodipine,
lovastatin, Synthroid, and Prilosec.
GENERAL: Awake and alert, answering questions appropriately, not in any acute
distress.
VITAL SIGNS: Afebrile, 97.7. Respiratory rate 21, pulse is at 74, blood pressure
106/73, oxygen saturation 97% sating on room air.
light.
HEART: Rate regular rhythm. No clicks, murmurs, or gallops noted.
ABDOMEN: Soft, nontender. No hepatosplenomegaly noted.
EXTREMITIES: No clubbing or edema noted.
LABORATORY DATA: Troponin has been negative. ProBNP 123.1. Potassium 3.3.
Magnesium 1.8. TSH is 0.029. INR is 0.93.
IMPRESSION: An 82-year-old female with questionable new onset atrial fibrillation.
She is not on any anticoagulation or any beta blockers or rate control medication.
I agree with starting anticoagulation to reduce her risk of cardiovascular CVA. We
would like her to follow up as outpatient so we could put on Holter monitor or Zio
monitor to examine data, to examine heart rate. I would also like to get
ultrasound as an outpatient. She is stable for discharge from a cardiac
standpoint. Currently, right now she is in normal sinus rhythm and has not had an
episode of any PAF since the EMS transport ride yesterday. We would like her to
follow up in the office in a week or two. This plan was discussed with Dr. Najeeb
Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22749804
CONSULTATION
CONSULTATION
***************
INDICATION: Atrial fibrillation/atrial flutter.
HISTORY OF PRESENT ILLNESS: This is an 88-year-old female who has a previous
medical history of CAD with CABG in the past, aortic valve replacement, who has
been seen today by Cardiology due to an episode of AFib/Aflutter with RVR last
night. Heart rate beats into the 140s with placement on Cardizem drip at that
time. The patient was seen today, heart rate, Aflutter, in the 120s. The patient
denies any sort of chest pain or shortness of breath at this time. Blood pressures
appear to be stable. Cardizem is going on 15 mL per hour. She is on amiodarone
and metoprolol for nonsustained VT in the past. Does have a LINQ monitor as well.
The patient has Pseudomonas bacteremia, is on IV cefepime. Primary language is
Spanish, but does speak English. Appears to have some confusion noted, talking to
herself when nobody else is in the room.
PAST MEDICAL HISTORY: Previous medical history, has a history of diabetes;
hypertension; hyperlipidemia; hypothyroid; CVA; DVT; GERD; breast cancer right
side, and seizures.
PAST SURGICAL HISTORY: Cholecystectomy, breast surgery, knee surgery, aortic valve
replacement, LINQ recorder.
SOCIAL HISTORY: No history of smoking, alcohol use, or illicit drug use.
FAMILY HISTORY: She has a family history of diabetes. No CAD in family history.
ALLERGIES: SULFA ANTIBIOTICS.
HOME MEDICATIONS: She is on Protonix, Carafate, Toprol-XL, mag ox, Lipitor,
Pletal, Keppra, amiodarone, Fosamax, Plavix, and Synthroid.
GENERAL: The patient is awake and alert, answering questions partially in Spanish,
partially in English, not in any acute distress.
VITAL SIGNS: The patient is afebrile at 98.5 Respirations are at 20. Pulse is at
120, Aflutter. Blood pressure 126/70. Oxygen sat at 97% on room air.
light.
HEART: Heart rate irregular rhythm.
ABDOMEN: Soft and nontender. Bowel sounds are present.
EXTREMITIES: No edema or clubbing noted.
LABORATORY DATA: Troponin negative. Last mag was 22, last potassium 4.6. Last
creatinine was 0.8. Hemoglobin 11.8.
DIAGNOSTIC STUDIES: Chest x-ray showed mild left basilar atelectasis. EKG showed
atrial flutter. Ventricular rate 145.
IMPRESSION: An 88-year-old female who presents with AFib/Aflutter. Heart rate
currently 120s, atrial flutter. The patient is relatively asymptomatic with no
shortness of breath and no chest pain noted. Denies any palpitations at this time.
We will work on giving her a ventricular rate better controlled. Continue on
diltiazem drip. Change Toprol-XL to Lopressor so we can adjust the rate
accordingly, on amiodarone for NSVT, on Lovenox at this time. We will transition
to oral anticoagulation at the time of discharge. We will obtain echo if unable to
compare on her own. We will get doing a TEE cardioversion, maybe Monday or
Tuesday. We will continue to monitor heart rate and blood pressure.
ABRAM BASINGER
D: **/**/**** 9:52:43 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22749617
CONSULTATION
CONSULTATION
***************
INDICATION: Elevated troponin and chest pain.
HISTORY OF PRESENT ILLNESS: This is a 73-year-old female who has been seen for
chest pain and elevated troponin. The chest pain occurred last night, lasted for
about 30 minutes. Chest pain was described as a burning sensation and midsternal.
No shortness of breath was associated with it. She was lying in bed, not exerting
herself when chest pain happened. Was given Norco and morphine and pain went away.
Earlier that day, she had an EGD performed, found to have old specks of blood noted
in the oropharynx, most likely due to recurrent nosebleeds, moderate amount of
partially digested food particles seen in the stomach, and mild superficial
gastritis. She is being seen today in the hospital for her recurrent epistaxis
with significant blood loss requiring blood transfusion. She has a history of PAF,
on Eliquis. She was taken off of Eliquis and they are also holding aspirin at this
time. Troponins were taken last night. After episode of chest pain, troponin was
0.096 and then 0.097. Today, talking to her, she did not have any chest pain, she
did not have any other episodes ever since. She is in normal sinus rhythm on the
monitor.
PREVIOUS MEDICAL HISTORY: She has a history of diabetes, hypertension,
hyperlipidemia, hyperthyroidism, depression, carotid stenosis with left carotid
endarterectomy, PVD, sinus brady with pacemaker, arthritis, CKD, and PAF.
PREVIOUS SURGICAL HISTORY: Pacemaker insertion, cholecystectomy, wrist surgery,
carpal tunnel release, left carotid endarterectomy.
SOCIAL HISTORY: Former smoker. Does not use alcohol. Does not use illicit drugs.
FAMILY HISTORY: Mother had heart disease. No other cardiac issues in the family
noted.
ALLERGIES: She is allergic to LIPITOR.
MEDICATIONS: She is on midodrine, Celexa, Mag-Ox, Crestor, aspirin, omega-3,
Synthroid, Lantus, Mysoline, Myrbetriq, and Aricept.
acute distress.
VITAL SIGNS: Afebrile at 98.5. Respirations are 20. Pulse 69, normal sinus
rhythm. Blood pressure 120/40. Oxygen level 96% on room air.
LUNGS: Clear to auscultation. Decreased breath sounds present.
ABDOMEN: Soft. Nontender. Bowel sounds present.
EXTREMITIES: She has no edema or clubbing noted.
LABORATORY DATA: Potassium 4.3. Creatinine 1.5 today, from 1 yesterday. Most
recent troponin 0.077. Hemoglobin today 9.2.
DIAGNOSTIC STUDIES: Chest x-ray was done during the chest pain episode and showed
no acute process.
IMPRESSION: This is a 73-year-old female who recently presented to the hospital
for epistaxis and anemia. She is being seen today for an episode of chest pain and
elevated troponin. This morning, she is chest pain-free. EKG reviewed from last
night, unremarkable. Troponin was at 0.096 maybe due to AKI, creatinine went up
0.5 points. Chest pain described as a burning sensation. No shortness of breath.
Not with activity, atypical chest pain. We will get echo and continue to trend
troponin. Hold off on doing stress test unless chest pain were to recur or
troponin were to continue to elevate or become positive.
ABRAM BASINGER
D: **/**/**** 8:18:09 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22749582
CONSULTATION
CONSULTATION
***************
INDICATION: Edema and CHF.
HISTORY OF PRESENT ILLNESS: This 99-year-old female who was brought to the
emergency department with hypoxia. She is a current resident of Oakwood, and staff
noticed that there was an increasing shortness of breath in the emergency
department, and there was chest x-ray done and showed mild edema and cardiomegaly.
Shortness of breath improved after one dose of IV Lasix and oxygen placed. She was
also feeling very weak at that time and also complaining of burning on urination.
PAST MEDICAL HISTORY: She has a previous medical history of valvular heart disease
with aortic valve replacement, history of PAF, but she is unable to take
anticoagulant due to falls. History of hypertension, hyperlipidemia, CKD, type 2
diabetes, cardiac catheterization in 2010, hypothyroid, neuropathy, dizziness.
PAST SURGICAL HISTORY: She has a past surgical history of aortic valve replacement
in 2010, hysterectomy, thyroid surgery, appendectomy and cholecystectomy.
FAMILY HISTORY: Mother and sister both died of heart disease and daughter also has
heart disease.
SOCIAL HISTORY: She has not smoked and does not use alcohol and does not use any
illicit drug use.
ALLERGIES: She has allergies to IODINE and SULFA ANTIBIOTICS.
HOME MEDICATIONS: Glucotrol, Seroquel, Keflex, potassium chloride, ferrous
sulfate, _____, gabapentin, lactulose, Paxil, Tylenol, Toprol-XL, baby aspirin,
Lasix 40, vitamin D3, Synthroid.
GENERAL: The patient is awake, but lethargic, answering questions appropriately,
not in any acute distress.
VITAL SIGNS: Afebrile at 97.5, respiratory rate 18, pulse is at 51, blood pressure
122/62, she is saturating at 98% on 2 liters.
light.
HEART: Irregular rate.
guarding noted.
EXTREMITIES: Nonpitting lower extremity edema.
NEUROLOGICAL: Cranial nerves grossly intact.
LABORATORY DATA: ProBNP elevated at 4198. Troponin is 0.017. Potassium 4.3,
creatinine 1.4. Hemoglobin 12.5. Hemoglobin A1c is _____. Chest x-ray showed
cardiomegaly with mild edema.
IMPRESSION: This 99-year-old female who presented with shortness of breath and CHF
exacerbation. She is resting comfortably on oxygen right now. Last echo in 2020
showed EF 50 to 55%, left ventricle systolic function was normal, moderate MI, and
severe TR with RCP of 81. IV Lasix given in the emergency department. We will do
one more order of IV Lasix and transition over to oral. Continue to watch heart
rate and blood pressure. Primary care team and hospice consult. She is DNRCC. We
will continue to follow her.
ABRAM BASINGER
D: **/**/**** 9:14:02 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22741337
CC:
CONSULTATION
CONSULTATION
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INDICATIONS: Weakness and history of CAD.
HISTORY OF PRESENT ILLNESS: This is a **-year-old-old male who presented to
hospital with weakness. This weakness has been gradually getting worse over the
past couple of weeks. He has also been having decreased appetite and unsteady
gait. He is also having increased sleepiness and the blood sugars are fluctuating.
With this increasing fatigue and weakness, he does have a history of CVA, wife was
concerned given his symptoms that he might have a repeat CVA, and brought him into
the emergency department.
He was seen in the office last, 07/09, where we gave results of Holter monitor.
Three episodes of PAF were found at that point. Echo was recently done, showed EF
of 49%, mild to moderate MR, impaired relaxation diastolic dysfunction, LVH, normal
LVEDP.
The patient has a previous medical history of CAD needing a CABG in 2017, three-
vessel LIMA to LAD, VG to RI, and then in 2019, he had stent to the OM and then
angioplasty to the ostial, ramus.
PAST MEDICAL HISTORY: He has also had previous medical history of CVA,
hyperlipidemia, arthritis, GERD, OSA, hypertension, and type 2 diabetes.
PREVIOUS SURGICAL HISTORY: Thoracentesis, colonoscopy, CABG x3 and cataracts.
FAMILY HISTORY: Unknown to patient.
SOCIAL HISTORY: He is a former smoker. Drinks 1 beer glass of wine nightly and
does not use any illicit drugs.
ALLERGIES: He has allergies to TORSEMIDE.
HOME MEDICATIONS: Gabapentin, Plavix, Eliquis, Coreg, Flomax, Lipitor, albuterol,
Bumex and Humalog.
GENERAL: The patient is awake and alert, answering questions, not in any acute
distress.
VITAL SIGNS: The patient is afebrile at 97.3, respiratory rate at 18, blood
pressure 117/60. He is satting at 99% on 3 L nasal cannula.
light.
HEART: Rate regular and rhythm.
guarding noted.
NEUROLOGICAL: Cranial nerves are grossly intact.
LABORATORY DATA: Potassium is 3.7. Creatinine is 3.6, does have history of CKD,
follows with Dr. Ullah of Nephrology. Magnesium 2.1. Hemoglobin 11.6. Troponin
on admission was 0.078. Positive for proteins in urine.
IMPRESSION: This 71-year-old male has been seen for a generalized weakness.
Recent echo showed a low normal EF and no significant arrhythmias and no current
chest pain at this time. We will not do any stress test and we will continue to
trend labs and continue to monitor telemetry and vital signs. If chest pains were
to present, would look at doing stress test at that time. This plan was discussed
with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 7:58:21 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22741216
CC:
CONSULTATION
CONSULTATION
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INDICATIONS: Elevated proBNP and elevated troponin.
HISTORY OF PRESENT ILLNESS: A 60-year-old male came to the emergency department
for shortness of breath and chills. Shortness of breath has been going on for one
day. CT of the chest showed right perihilar opacities corresponding with two
ground-glass opacities on CT. More ground-glass on the right lower lobe, noting
infection. The patient does have a history of COPD. Antibiotics have been
started. The patient also has a history of chronic CHF on metolazone and torsemide
at home, and proBNP elevated to 2013. Troponin was also elevated to 0.049. The
patient also has a history of PAF, on Xarelto and metoprolol. The patient was also
found to be hypokalemic on admission; last potassium is 2.9, replacements are
given. Also found to be hypotensive; chronically using midodrine.
Last echo showed ejection fraction of 50-55%. Last TEE showed ejection fraction of
50-55%. Mild-to-moderate MR. No pericardial effusion at that time. He was
shocked for AFib.
MEDICAL HISTORY: He has a history of GERD, COPD, sleep apnea, hyperlipidemia,
hiatal hernia, depression, anxiety, anemia, PAF, CKD, CHF, diabetes, asthma,
emphysema, fibromyalgia.
PAST SURGICAL HISTORY: Carpal tunnel, left total hip, gastric sleeve, and hernia
repair.
FAMILY HISTORY: Mother had history of CAD. Father had history of CAD as well.
Siblings with a history of cancer.
SOCIAL HISTORY: He was a former smoker. Denied to have any drug or alcohol
intake.
HOME MEDICATIONS: He is on metolazone, Singulair, Norco, potassium, Aldactone,
Xarelto, Demadex, prednisone, Lopressor, Ranexa, metformin, Zyrtec, Baclofen,
midodrine, Cymbalta, Prilosec, Zocor, Remeron, and levothyroxine.
ALLERGIES: He has allergies to TRAMADOL and GABAPENTIN.
any acute distress.
VITAL SIGNS: Respiratory rate at 18. Pulse is at 79. Blood pressure 108/60. He
is 97% on 3 liters. Last temperature was 97.9.
light.
HEART: Rate irregular.
guarding noted.
EXTREMITIES: 1+ pitting bilateral lower extremities.
LABORATORY DATA: Potassium 2.9, creatinine is at 1.2, magnesium is at 2.2. ProBNP
2013. Troponin is 0.049. Hemoglobin at 10. COVID-19 was not detected.
IMPRESSION: This is a 60-year-old male who presents with shortness of breath,
elevated proBNP and troponin. We will continue to treat for pneumonia. Continue
diuretics as well at this time. We will get a new echo to see ejection fraction.
Continue anticoagulation for PAF and metoprolol. If heart rate continues to climb,
may need to add digoxin. Currently not having any chest pain. Elevation in
troponin may be due to elevated proBNP or pneumonia itself, not suspected of ACS.
We will continue to follow alongside with the patient. This plan was discussed
ABRAM BASINGER
D: **/**/**** 8:53:05 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22739358
CC:
CONSULTATION
CONSULTATION
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INDICATION: CHF and shortness of breath.
HISTORY OF PRESENT ILLNESS: This is an 81-year-old male who presented to the ER
with shortness of breath. Shortness of breath has been going on for the last three
to four days. He got extremely dyspnea on exertion, unable to walk short distances
due to shortness of breath. He was originally seen at the office on 07/29 for
shortness of breath and at that time he was found to be in AFib with RVR, heart
rate in the 110s. Amiodarone loading dose was given at that time to help try to
convert _____ also had leg edema from recent vacation where he was increasing the
salt intake. Today, he presents with shortness of breath, elevated proBNP of
16,423, troponin elevated at 0.054. He has no complaints of any chest pain or
palpitations.
Recent echo on **/**/**** showed LV function in size is normal, EF of 52%, LVH,
normal LVEDP, mild aortic stenosis with mean pressure gradient of 26.74 mmHg, mild
AR, moderate MR, no pericardial effusion.
PAST MEDICAL HISTORY: He has previous medical history of hypertension and
hyperlipidemia, CAD, sleep apnea, arthritis, acid reflux, enlarged prostate, and
chronic kidney disease stage III, and atrial fibrillation.
PAST SURGICAL HISTORY: He has previous surgical history of CABG x3, then CABG x2,
multiple coronary angioplasties, last one was done in 2014. He has had hernia
repair surgeries, cholecystectomy, hip angioplasty, left total hip replacement, and
bilateral cataract surgery.
FAMILY HISTORY: Mother deceased with heart disease. Father had emphysema.
Siblings have a history of cancer.
SOCIAL HISTORY: He is a former smoker. No alcohol intake. No illicit drug use.
CURRENT MEDICATIONS: Amiodarone, Lasix, Eliquis, metoprolol, Protonix, Fosamax,
and iron complex.
ALLERGIES: LIPITOR.
GENERAL: The patient is awake and alert, answering questions appropriately, in no
acute distress.
VITAL SIGNS: The patient is afebrile. Last blood pressure was 120/80, pulse 61,
normal sinus rhythm. Respirations are 20, on room air.
light.
HEART: Regular rhythm.
guarding are noted.
EXTREMITIES: Nonpitting edema noted on extremities.
LABORATORY DATA: Potassium 5.4, creatinine 2.9. ProBNP 16,423. Troponin 0.054.
Mag 2.1. Hemoglobin 14.2. Chest x-ray shows cardiac silhouette enlargement, which
is unchanged. No evidence of edema or pneumonia.
IMPRESSION: This is an 81-year-old male who presented with shortness of breath and
CHF exacerbation. Seen today by Cardiology, has a history of PAF, was in AFib most
recently in the office, now in normal sinus rhythm. Heart rate in the 60s.
Elevated proBNP, on Lasix b.i.d. Elevated kidney function. Renal has been
consulted. We will decrease Lasix to one today to help with renal function,
appreciate Renal's recommendations. Currently, no acute distress or shortness of
breath. He does state that the shortness of breath has gotten better since the
dose of Lasix last night. Urine output has about 1200 out. Continue to watch for
accurate I's and O's. Echo done in office two months ago. We will get new echo
due to shortness of breath. We will continue to trend troponin, likely elevated
due to AKI. We will continue to monitor him closely. This plan was discussed with
Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 8:03:20 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22739292
CC:
CONSULTATION
CONSULTATION
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INDICATION: Anticoagulation.
HISTORY OF PRESENT ILLNESS: This is an 87-year-old female who presented to
Emergency Department with black tarry stool and weakness for about 2 weeks.
Hemoglobin on arrival was 7.3, and it dropped down to 6.6 yesterday. A total of 3
units of blood have been given to her, and she is going to get an EGD done today.
The patient is on Eliquis for PAF. This was found on Holter monitor back in 2019,
on 2.5 of Eliquis two times a day. Last stress test was done in 2019. No
myocardial ischemia at that time. EF was 67%.
PAST MEDICAL HISTORY: She has previous medical history of CAD, MI, hyperlipidemia,
hypertension, venous insufficiency, PVD, fatigue, anxiety, pulmonary nodule, COPD,
PAF, adenocarcinoma of the left lung, right mid lobe pulmonary infiltrates, and
former smoker.
SURGICAL HISTORY: She has had lung biopsy done, cholecystectomy, and PTCA.
SOCIAL HISTORY: She was a former half-pack smoker, had no prior alcohol use. No
prior illicit drug use.
FAMILY HISTORY: Mother and father and brother all are deceased and all had heart
disease.
HOME MEDICATIONS: Currently on aspirin, ProAir, quinapril, Crestor, Eliquis,
metoprolol, Anoro Ellipta and hydrochlorothiazide.
ALLERGIES: No known drug allergies.
GENERAL: The patient is awake and alert, answering all questions appropriately, in
no acute distress.
VITAL SIGNS: Afebrile at 98.7. Respirations are 18. Pulse at 75. BP 132/63. O2
sat at 94% on room air.
light.
LUNGS: Clear to auscultation. No rhonchi or crackles noted.
HEART: Regular rhythm. No murmurs, clicks, or gallops noted.
ABDOMEN: Soft.
EXTREMITIES: No edema or clubbing noted.
LABORATORY DATA: Hemoglobin today 8.7. Creatinine 0.6, potassium 4.3. Troponins
were negative.
IMPRESSION: This is an 87-year-old female who presented to the Emergency
Department for black tarry stool, weakness, and having acute GI bleed, having a
history of being on NOAC for PAF. I was very hesitant on stopping NOAC due to risk
of stroke. I went into the room where daughter and son were present and educated
them about the risks of bleeding while being on NOAC. At this time, we will
continue to hold Eliquis until GI bleeding has resolved. GI is consulted and an
EGD is planned for later today. We will also look at outpatient, getting another
monitor on her to see PAF burden, and see how necessary NOAC is. This plan was
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22728193
CC:
CONSULTATION
CONSULTATION
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REASON FOR CONSULT: Elevated troponin.
HISTORY OF PRESENT ILLNESS: This **-year-old gentleman who looks older than his
age, presented to the emergency department for increased weakness and shortness of
breath. This has been going on for a few days. He has also had some nausea and
abdominal pain as well. He has a history of cirrhosis and recurrent ascites and
recurrent paracentesis. In the emergency room he was slightly tachycardic at 108
beats per minute. He does have a known right bundle branch-block noted on EKG.
His troponins were slightly abnormal at 0.085. He was recently just hospitalized
last month for chest pain and shortness of breath. At that time echo was done
which deemed to just treat medically.
Echo on **/**/**** showed left ventricle systolic function is normal. EF is
usually estimated at 50-55%. Sclerotic but non-stenotic aortic valve. No evidence
of any pericardial effusion.
PAST MEDICAL HISTORY: Cirrhosis of the liver due to previous alcohol use,
diverticulitis, skin cancer, GERD, carotid artery stenosis, osteoarthritis,
orthostatic hypotension, abdominal hernia.
PREVIOUS SURGICAL HISTORY: Bilateral ACL knee repair. Basal cell cancer removal.
Colon resection. Multiple paracenteses. Hernia repair _____.
ALLERGIES: No known drug allergies.
SOCIAL HISTORY: Negative. He does not smoke. He is not currently using alcohol.
He has a strong alcohol use in the past. No illicit drugs.
FAMILY HISTORY: Father had liver cancer. Mother had brain cancer.
HOME MEDICATIONS: Protonix, iron, vitamin B1, Prozac, Zofran, vitamin C,
Aldactone, Klonopin, Plavix, Midodrine, melatonin, gabapentin, and rifaximin.
GENERAL: The patient is awake and alert, answering questions appropriately, looks
older than known age.
VITAL SIGNS: Afebrile 97.8, respiratory rate at 18, pulse 104, blood pressure
142/75, O2 sat is 97% on room air.
light.
HEART: Rate regular. No murmurs, gallops or clicks noted.
ABDOMEN: Abdomen has abdominal binder.
EXTREMITIES: No edema, cyanosis or clubbing noted.
NEUROLOGIC: Cranial nerves grossly intact.
LABORATORY RESULTS: Troponin 0.085, proBNP 2521 creatinine is at 1.0, hemoglobin
7.5.
DIAGNOSTIC STUDIES: Chest x-ray shows mild atelectasis changes in left base and
mild elevation of the right hemidiaphragm, is chronic. No other disease.
IMPRESSION: This is a **-year-old male who presented to the emergency department
for weakness and shortness of breath. Today shortness of breath has improved. He
is not feeling any sort of chest pain. Troponins were slightly elevated at 0.085.
We will continue to trend troponins. Echo was last done in the last visit 1 month
ago, we will not repeat at this time. If chest pain were to present, would look at
getting the stress test. We will continue to watch hemoglobin at this time as well
and continue with supportive care at this time.
ABRAM BASINGER
D: **/**/**** 8:48:11 T: **/**/**** 8:52:43 AB/*******
Job#: ******* Doc#: 22728109
CC:
CONSULTATION
CONSULTATION
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emergency department for chest pain. Chest pain has been on and off for the last
couple of months. Yesterday, it intensified and increased in frequency. Chest
pain is described as a pressure that goes across the entire chest. Denies any
shortness of breath associated with it. This chest pain is independent of
activity. The patient is usually inactive and sitting when the chest pain occurs.
She then continues to breathe and rest until chest pain goes away. The patient
denies any dizziness or palpitations or increased leg edema. Today, she has not
felt any of the chest pains since clearing by the Squad. Troponins initially had
been negative. EKG showed no changes from her previous EKGs.
The patient had a heart catheterization in 05/2020. At that time, the left main
was patent, LAD mid had 50% stenosis, circ had mild disease and had 50% stenosis,
and RCA had mild disease also noted. At that point in time, echo showed the
patient had an EF of 30%, akinetic mid-apical wall segments, possible Takotsubo.
We will get repeat echo. Also during the heart catheterization, she was having
episodes of bradycardia. Permanent pacemaker was placed at that time.
PREVIOUS MEDICAL HISTORY: She has a medical history of hypertension,
hyperlipidemia, emphysema, chronic obstructive lung disease, type 2 diabetes,
osteoporosis, and history of SVT.
PREVIOUS SURGICAL HISTORY: She had her cataracts removal and lens implants,
pacemaker insertion, TAH-BSO.
FAMILY HISTORY: Mother had known CVA, father had diabetes, sister had diabetes as
well.
SOCIAL HISTORY: She is a former smoker. Denies any alcohol use. Denies any
illicit drug use.
ALLERGIES: She has allergy to LOPRESSOR, NORVASC, PROMETHAZINE, and LISINOPRIL.
HOME MEDICATIONS: She is on ferrous sulfate, metformin, albuterol, Coreg, Plavix,
Aldactone, atorvastatin, Pulmicort, Atrovent, Mobic, Cozaar, Lasix, Fosamax, baby
aspirin, and she wears oxygen at night.
any acute distress.
VITAL SIGNS: Afebrile 98.4. Pulse is 83. Respiratory rate at 17. Blood pressure
131/74. Satting at 100%.
light.
LUNGS: Clear to auscultation. Breath sounds are present. No rhonchi.
HEART: Rate regular. No murmurs, clicks, or gallops noted.
guarding are noted.
EXTREMITIES: No cyanosis or clubbing noted. No edema.
LABORATORY DATA: Troponins have been negative. Creatinine 0.6. Potassium 3.7.
A1c is at 8. Hemoglobin 11.9.
DIAGNOSTIC STUDIES: EKG showed sinus tachycardia. Heart rate 111. No ST segment
changes. Echo is pending.
for chest pain that has been going on for three months. Chest pain is described as
a chest pressure that goes all the way across the chest, but she does have known
CAD 50% last year. At that time, she also had decreased EF, possibly Takotsubo.
We are repeating echo at this time. Troponins have all been negative. Given her
age, we will continue to treat medically and conservatively at this point in time.
If troponins would elevate and chest pains were to intensify, we talked to her and
her family about looking into getting the heart cath. This plan was discussed with
Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 9:34:38 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22694284
CC:
CONSULTATION
CONSULTATION
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INDICATION: Bradycardia.
HISTORY OF PRESENT ILLNESS: This is a 60-year-old male, who came into the hospital
for an elective neurosurgical procedure. He had cervical spondylosis with
myelopathy, status post C3 through 7 laminectomy and C2 through T2 instrumentation
and fusion with neuromonitoring. He is postop day 1. He is presenting with
bradycardia. Heart rate is sinus brady, in the 40s. During the procedure, heart
rate went down to about 43. Atropine was given in the PACU. Today, heart rate is
still down in between 40s and 50s. The patient was just recently seen in office in
05/2021 for surgical clearance. At that time, heart rate was in the 50s as well.
He is on 25 mg of Coreg b.i.d. This has been held while he is here at the
hospital. Also, he is having hyperkalemia, potassium 6.1 today. Nephro is
following. Also, found to be hypertensive today as well.
Last echo was done in 04/2021 showed EF to be 40%-45%, severely dilated left
ventricle, moderate left ventricle hypertrophy, and ascending aorta was dilated at
4.27 cm. Stress test in the office showed EF to be 48%. No ischemia on stress
test.
PAST MEDICAL HISTORY: Hyperlipidemia, CHF, CKD, diabetes, COPD, sleep apnea,
aneurysm of the ascending aorta, hypothyroidism, hypertension, history of blood
clots, asthma.
PREVIOUS SURGICAL HISTORY: He has had toe amputation in the right great toe, wrist
fracture surgery, liver transplant in 2015, ankle surgery, ERCP, and eye surgery.
FAMILY HISTORY: He has a family history of cancer on his mother and father's side.
SOCIAL HISTORY: He does not smoke. He does not abuse any alcohol, and he does not
use any illicit drugs.
ALLERGIES: He has allergies to PENICILLIN.
HOME MEDICATIONS: He is on Lacuna, Tessalon, mag ox, chlorthalidone, sodium
bicarb, Coreg, Ultram, _____, Amaryl, Imdur, Lipitor, prednisone, Prograf,
Synthroid, albuterol, Singulair, Procardia, and gabapentin.
any acute distress.
VITAL SIGNS: Afebrile at 97, respiratory rate at 16, pulse ox 52, sinus brady,
blood pressure 169/78, and he is satting at 98% on 2 liters nasal cannula.
HEENT: Head is atraumatic, normocephalic. Pupils are equal and reactive to light.
LUNGS: Clear to auscultate. No wheezes or rhonchi noted.
HEART: Regular rhythm. No clicks, gallops, or murmurs noted.
guarding.
LABORATORY DATA: Potassium 6.1. Creatinine 2.5. Hemoglobin 8.8.
EKG done last night showed sinus brady, heart rate 45.
IMPRESSION: This is a 60-year-old male who came in for elective surgery, starting
episodes of bradycardia and hypertension as well as hyperkalemia. We will continue
to watch bradycardia. He is bradycardic at baseline. Heart rate in office 51.
The patient is asymptomatic with a heart rate like this. I will continue to hold
Coreg at this time. For hypertension, p.r.n. hydralazine as well as oral
medication. Nephrology will continue to follow with potassium levels. An echo
ordered. He is not on dopamine drip at this time. We will continue to watch heart
rate. This plan was discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 9:02:19 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22694193
CC:
CONSULTATION
CONSULTATION
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CHIEF COMPLAINT: Chest pain, shortness of breath.
HISTORY OF PRESENT ILLNESS: A 49-year-old male, came into the emergency department
for shortness of breath and chest pain. The patient was wheezing. When in the ER,
IV steroids and bronchodilators were given at that time. Symptoms have improved
since then. States that these symptoms have been going on for the last two days.
Chest pain is described as a chest tightness across the chest. He feels it mostly
when he is breathing heavily. Chest is tender to palpate. Has a history of COPD,
and sees Pulmonology, Dr. Ranginwala, outpatient.
The patient also has a history of CAD, had a heart cath in 11/2020. At that time,
left main was patent. Circ had mild disease. Ramus had mild disease. LAD had 80%
stenosis, and a stent was placed in the mid LAD at that time. Currently, on
Plavix. In 03/2021, echo was done. Showed EF was 50% to 55%. The left
ventricular systolic function was normal. No significant valvular disease at that
time, and then stress test was just performed in 04/2021, showed no EKG changes
suggestive of ischemia. No irreversible ischemia noted.
PAST MEDICAL HISTORY: The patient has a previous medical history of CAD requiring
stents, COPD, diabetes, history of PE, asthma, hypertension, GERD, hyperlipidemia,
bipolar, sleep apnea, chronic back pain.
PAST SURGICAL HISTORY: Cholecystectomy, tympanoplasty, back surgery,
tonsillectomy, and toe surgery.
FAMILY HISTORY: Mother has heart failure, diabetes, and cancer. Father has
hypertension, hyperlipidemia, diabetes and cancer as well.
SOCIAL HISTORY: He is a former smoker. Denies using any alcohol and denies using
any illicit drugs.
ALLERGIES: He has multiple allergies, BUSPAR, GEODON, PENICILLIN, ULTRAM,
DILAUDID, LEVOFLAXACIN, MORPHINE, HYDROMORPHONE, DUST, PAROXETINE, PHENYTOIN,
TRAMADOL, DAYPRO, ERYTHROMYCIN, FLOMAX, FLONASE.
HOME MEDICATIONS: He is on albuterol, Bentyl, Mucinex, DuoNeb, Remeron, Pepcid,
Valium, Zyprexa, Plavix, Claritin, simethicone, Flonase, iron, aspirin, Singulair,
Lantus, Lipitor, Zanaflex, Eliquis, Cardura, Norvasc, metoprolol, Dexilant,
Carafate, Protonix, gabapentin, and vitamin D.
GENERAL: The patient is awake, alert, and answering questions appropriately, in no
current distress.
VITAL SIGNS: Afebrile at 97.9; respiratory rate is at 18; pulse is at 86, blood
pressure 128/88, and he is satting 92% on 2 liters nasal cannula.
HEENT: Head is normocephalic, atraumatic. Pupils are equal and reactive.
LUNGS: Clear to auscultate. Inspiratory wheezes noted. No rhonchi.
ABDOMEN: Soft, nontender. Bowel sounds present. No hepatosplenomegaly or
guarding.
LABORATORY DATA: Troponins have been negative. Potassium 4.6. Creatinine 0.8.
D-dimer not elevated.
CTA chest showed no evidence of pulmonary embolism or acute pulmonary abnormality.
IMPRESSION: This is a 49-year-old male who presented to the hospital with chest
pain and shortness of breath. Overall feeling better. He still endorses some
shortness of breath and chest pain. Chest pain is tightness, usually associated
when he is feeling short of breath. Chest is tender to palpate. Troponins have
all been negative. No EKG changes to show any ischemia. Stress test and
ultrasound were done earlier this year. We will repeat echo due to the shortness
of breath and check EF, and then evaluate if these symptoms do not seem cardiac in
origin. More than likely, they are secondary to COPD exacerbation. We will
continue to trend troponin and continue to watch symptoms. He did have known mild
disease on last heart cath. If chest pain is noted to intensify or troponins were
to be elevated, we would look at doing a heart cath at that time. This plan was
ABRAM BASINGER
D: **/**/**** 8:04:22 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22694098
CC:
CONSULTATION
CONSULTATION
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HISTORY OF PRESENT ILLNESS: The patient came into the hospital for abdominal pain,
nausea, vomiting, diarrhea, was found to be septic with a probable intra-abdominal
source. Last night, he went into AFib with RVR with heart rate getting as high as
190s. The patient has a history of AFib with RVR in office where Holter monitor in
_____ to have 20 episodes in three days. Most of these happened at night, possibly
sleep apnea contributing to these episodes. This episode also happened that night.
Today, heart rate is better controlled in 130s, still in AFib. He is on
anticoagulation with Eliquis. He is on diltiazem drip, and he is on Coreg.
PAST MEDICAL HISTORY: He has a past medical history of CAD with stents in the
past, angiogram to mid and distal LAD and that was in 08/2020, also has a history
of PAF, GERD, hypertension, BPH, history of smoking, and chronic back pain.
PAST SURGICAL HISTORY: He has had a hernia repair, rotator cuff repair,
appendectomy, and knee surgery.
SOCIAL HISTORY: He smokes a quarter of a pack a day. He uses alcohol socially,
and he does not have any illicit drug use.
FAMILY HISTORY: His father has a history of AAA, and mother has a history of brain
cancer.
HOME MEDICATIONS: Eliquis, Lipitor, Plavix, lisinopril, metoprolol, Flomax,
Flonase, Advair, and ProAir.
GENERAL: The patient is awake, alert, and answering questions appropriately, in no
acute distress.
VITAL SIGNS: Afebrile at 98; respiratory rate is at 20; pulse at 146, AFib; blood
pressure 140/80, and satting at 95% on room air.
HEENT: Head is normocephalic and atraumatic. Pupils are equal and reactive.
HEART: Rate _____, irregular rhythm. No murmurs, gallops, or clicks noted.
guarding.
EXTREMITIES: No cyanosis or clubbing noted. No edema noted.
NEUROLOGICAL: Cranial nerves are grossly intact.
LABORATORY DATA: Troponins are negative. ProBNP 343. Potassium at 4.2.
Creatinine 0.7. Procalcitonin 11.9.
DIAGNOSTIC TESTS: CT of chest showed the thoracic aorta measuring at 4.7 cm, no
aortic dissection given the motion and artifact. This is a new finding.
IMPRESSION: This is a 68-year-old male, being seen for AFib, RVR. Overall, the
patient is feeling well. Denies any palpitations, shortness of breath, or chest
pain. We will get heart rate under better control on switching to IV amiodarone
and also switching to Lopressor. Continue with anticoagulation. We will get echo
to rule out any sort of endocarditis. He will need a sleep study done as an
outpatient. AFib is likely a result of the septic infection. We will follow up
with thoracic aorta, CT of the chest on **/**/**** showed that thoracic aorta has
normal caliber. We will check up for this with Radiology.
PLAN: Discussed with Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 9:44:51 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22691896
CC:
CONSULTATION
CONSULTATION
***************
REASON FOR CONSULT: Dyspnea and chest pain.
HISTORY OF PRESENT ILLNESS: A 45-year-old female who came into the emergency
department complaining of shortness of breath, chest pain, and dizziness.
Shortness of breath is on exertion, and at that time, she was having chest pain,
left-sided pressure, and have been going on for approximately two weeks. She has
dizziness at baseline history of vertigo. Today, she denies any sort of chest
pain. She does endorse having back pain and some shortness of breath on exertion
still. She does state that her shortness of breath gets worse with humid air or
dust or allergens. Dizziness feels about at baseline with her vertigo. She was
just seen in the office this month. Stress test and ultrasound was done last
month. Echo was 56%, mild to moderate MR, impaired relaxation, diastolic
dysfunction, mild AR, and LVH. Stress test showed no ischemia at that time.
PAST MEDICAL HISTORY: She has a past medical history of hypertension,
hyperlipidemia, diabetes, vertigo, and iron deficiency anemia.
PAST SURGICAL HISTORY: Hernia repair.
SOCIAL HISTORY: She does not smoke. She does drink alcohol occasionally. No
illicit drug use.
FAMILY HISTORY: Family history of diabetes on her mother and father side. Mother
has a family history of CAD in the past.
HOME MEDICATIONS: Aspirin, doxazosin, iron, Levemir, losartan, metformin,
Aldactone, Zofran, and Crestor.
GENERAL: This patient is awake and alert, answering questions appropriately, not
in acute distress.
VITAL SIGNS: Blood pressure 136/90, pulse 76, normal sinus rhythm, respiratory
rate 14, O2 sats 100% on room air, afebrile at 98.2.
CHEST: Equal on expansion.
HEART: Heart rate is regular rhythm. No clicks, gallops or murmurs.
guarding.
DIAGNOSTICS: CTA of chest showed no evidence of PE or acute pulmonary
abnormalities. CT of the head showed no acute intracranial abnormalities. Chest
x-ray showed no acute process.
LABORATORY DATA: Troponin have been negative. Creatinine 0.7. Potassium 4.7.
A1c is 8. Hemoglobin 9.5. ProBNP not elevated.
IMPRESSION: A 45-year-old female who presents with dizziness, chest pain and
dyspnea. Chest pain has resolved. Troponins have been negative. Stress test last
month looked reassuring. Echo ordered. Vertigo seems to be at baseline. The
patient says *------* at this point in time.
Dyspnea: We will look at echo, seems to be triggering from her respiratory origin.
We will look and see what echo shows. Also continue to watch blood pressure and
heart rhythm. We will hold off on doing heart cath at this time. If dizziness
were to worsen, we will look at getting carotid ultrasound. Plan was discussed
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22690064
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Cardiac catheterization.
HISTORY OF PRESENT ILLNESS: This is a 59-year-old male. He was brought into the
hospital for hydration before cardiac catheterization. The patient has a history
of CKD stage 3 and diabetes mellitus type 2. Creatinine on admission was 2.2. IV
hydration started overnight to help kidneys drain cardiac catheterization. The
patient has been having chest pain that has been going on for almost a month, very
extensive cardiac history. Chest pain is midsternal, radiates down into the arm.
Very similar to chest pains of the past when he needed intervention done.
The patient has a very extensive cardiac history. He has had CABG x2 and several
cardiac catheterizations in the past. Most recent cardiac catheterization was in
March. No intervention was done at that time, just optimal medical therapy. He is
on multiple antianginal medications, even has induced morphine at times. Chest
pain has not been resolving with the antianginal medications. So, he was scheduled
for heart catheterization in our office. With his CKD, he is brought in for
hydration.
Last echocardiogram was in March of this year, showed EF to be 60% at that time.
Left ventricular systolic function is normal.
PAST MEDICAL HISTORY: He has a history of CAD requiring stents in the past and
CABG x2 in the past. He has history of diabetes, hypertension, hyperlipidemia,
CKD, GERD, and CVA.
PAST SURGICAL HISTORY: He has had CABG x2, appendectomy, elbow surgery, and
bunionectomy.
SOCIAL HISTORY: The patient does not smoke. The patient does not use any alcohol,
and the patient does not use any illicit drugs.
ALLERGIES: The patient has allergies to PENICILLIN, IBUPROFEN, ADHESIVE TAPE,
CODEINE, FENOFIBRATE, TRICHLORMETHIAZIDE, AND PAPER TAPE.
FAMILY HISTORY: Father has a history of heart disease, diabetes, hypertension, and
hyperlipidemia. Brother has a history of hypertension, hyperlipidemia, and
diabetes as well.
MEDICATIONS: He is on aspirin, atorvastatin, Celexa, Eliquis, glipizide, Imdur,
metformin, metoprolol, MS Contin, Norvasc, Plavix, Ranexa, and Zyrtec.
any acute distress.
VITAL SIGNS: The patient is afebrile, 97.9, blood pressure 108/66, respiratory
rate is 18, saturating 95% on room air, pulse at 61, normal sinus rhythm.
light.
HEART: Heart rate regular in rhythm. No clicks, gallops, or murmurs heard.
ABDOMEN: Soft and nontender. Bowel sounds are present. No guarding or rebound
tenderness.
LABORATORY DATA: Creatinine on admission is 2.2 with a GFR of 37, potassium 4.5.
Troponins are negative. A1c is 7.4. D-dimer not elevated. EKG showed sinus
brady.
IMPRESSION: This is a 59-year-old male who came into the hospital for hydration
before cardiac catheterization. Heart cath scheduled today at 9 o' clock with Dr.
Najeeb Ahmed. Dr. Varghese of Nephrology has been consulted because of this CKD.
Continue IV hydration at this point in time, n.p.o. at this point in time. We will
await for Dr. Varghese's recommendations before proceeding with cardiac
catheterization. He has a very extensive cardiac history of CAD with several
stents in the past, and with having CABG twice. We will look at coronary arteries
and see if any intervention can be done at this time. This plan was discussed with
Dr. Najeeb Ahmed.
ABRAM BASINGER
D: **/**/**** 8:08:10 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22689636
CC:
CONSULTATION
CONSULTATION
***************
Abram Basinger, FNP, dictating for Najeeb Ahmed, MD
INDICATIONS: CHF and elevated troponin.
hospital with hypotension. At the nursing home, blood pressure was 81/35 per the
patient�s wife and oxygen levels were in the 70s at that point in time. The
patient does have history of CAD, AFib, also requiring stents in the past. When in
the emergency department, troponins were elevated to 0.04. Denied any sort of
chest pain. ProBNP was also elevated at 2694, and edema was noted.
The patient has history of CAD with stents, most recent in 2018 with Dr. Kabir who
put stent to the RCA at that point in time. Last echo was done in 2018, at that
time, showed EF of 50%, moderate concentric left ventricular hypertrophy, moderate
dilated left atrium, moderate pulmonary hypertension at that time.
PAST MEDICAL HISTORY: Shingles, CAD with stents, postoperative ileus, black lung,
and cancer.
PREVIOUS SURGICAL HISTORY: Cholecystectomy, hernia repair, joint replacement,
appendectomy, hand surgery, cardiac surgery, and upper gastro endoscopy.
ALLERGIES: To AMBIEN.
SOCIAL HISTORY: Former smoker. No alcohol. No illicit drug use.
FAMILY HISTORY: Mother had cancer. No family history of CAD noted.
GENERAL: The patient is awake, confused, unable to answer questions appropriately,
frail, elderly.
VITAL SIGNS: Blood pressure 106/63, pulse 97 in AFib, respiratory rate at 16,
temperature 97.2, and satting at 95% on room air.
light.
LUNGS: Clear to auscultation. No wheezes or rhonchi present.
HEART: Heart rate irregular rhythm. No clicks, murmurs, or gallops.
ABDOMEN: Soft. Nontender. Bowel sounds present. No hepatosplenomegaly or
guarding.
EXTREMITIES: 2+ lower extremity edema noted. No cyanosis or clubbing noted.
NEUROLOGIC: Confused. Cranial nerves grossly intact.
LABORATORY DATA: Troponin elevated to 0.04. ProBNP 2694. Creatinine is at 1.1.
Potassium 3.9. Hemoglobin 8.9.
IMPRESSION: This frail and elderly **-year-old who presented to the hospital for
hypoxia and hypotension. Overall, stable today. Has history of AFib and CAD
requiring stents, and CHF. Troponin elevated to 0.04. No chest pain present.
Given age and state, we will optimize medical therapy. 2+ lower extremity edema
and shortness of breath. We will get a new echo to check EF evals. Continue IV
diuretics at this time. We will continue to trend troponin and ProBNP. Plan was
ABRAM BASINGER
D: **/**/**** 9:07:11 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22685057
CC:
CONSULTATION
CONSULTATION
***************
Abram Basinger, FNP, dictating for Najeeb Ahmed, MD
HISTORY OF PRESENT ILLNESS: This is a 67-year-old male who looks older than his
age, presented today for chest pain. Chest pain started 2 days ago. Chest pain is
left-sided, not associated with any shortness of breath. The patient describes the
pain as an aching pain. Does have a history of hernia repair last year. Has
abdominal binder on at this time. EKG completed showed normal sinus rhythm with
right bundle-branch block. No ST elevation. Troponins are elevated to 0.033.
The patient has been seen in the office. Last stress test was done in 01/2020, no
ischemia at that time. Last echo was done in 07/2020, EF 50% at that time.
PAST MEDICAL HISTORY: Has a history of basal cell carcinoma, CKD, GERD, abdominal
hernia, and liver cirrhosis.
PAST SURGICAL HISTORY: Knee surgery, gastrointestinal endoscopy, laparotomy,
exploratory upper gastric endoscopy, and hernia repair.
SOCIAL HISTORY: No history of smoking. Not currently using alcohol. Does have a
history of ETOH. No illicit drugs.
FAMILY HISTORY: No family history noted of any CAD.
MEDICATIONS: Prozac, Zofran, Demadex, vitamin C, Lasix, Aldactone, vitamin B1,
Ultram, Klonopin, Plavix, midodrine, Protonix, melatonin, gabapentin, ferrous
sulfate, and rifaximin.
PHYSICAL ASSESSMENT:
GENERAL: The patient is awake and alert, answering questions appropriately, looked
frail and elderly.
VITAL SIGNS: Blood pressure 144/75, pulse 97, respiratory rate at 20, temperature
99.2, satting on a 100% on room air.
light.
HEART: Heart rate regular. No murmurs, gallops, or clicks noted.
ABDOMEN: Has abdominal binder wrapped.
EXTREMITIES: No edema, cyanosis, or clubbing noted.
LABORATORY DATA: Troponin elevated to 0.033. Creatinine 1.1, potassium 4.8, pro-
BNP elevated at 2,487.
IMPRESSION: This 67-year-old male who is frail and elderly is complaining of chest
pain. Today chest pain has resolved. Troponins were elevated at 0.033. Chest
pain is left sternal, aching pain. The shortness of breath is not accompanied with
it right now, it was accompanied in the emergency department. EKG reviewed, right
bundle-branch block, which is known to the patient. Last stress test and echo were
over a year ago. Because of the elevated troponin, we will repeat stress test and
get a new echo completed, and we will continue to trend troponin.
PLAN: This plan was discussed with Dr. Najeeb Ahmed, MD.
ABRAM BASINGER
D: **/**/**** 8:33:07 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22684983
CC:
CONSULTATION
CONSULTATION
***************
***************
INDICATION: PAF.
HISTORY OF PRESENT ILLNESS: This is a 77-year-old male, came in to the hospital
for emesis, found to have acute pancreatitis, has a history of PAF, went into AFib
yesterday, rate controlled. Also, he is complaining of chest pain that started
last night, states the pressure in midsternum. It occurred after he just ate his
first meal for the first time.
The patient has previous history of PAF. Recent Holter worn showed 37% _____ in
AF, currently on Eliquis for anticoagulation and metoprolol 50. Also, in office in
April had an echo, showed EF 54% and stress test showed no ischemia at that time.
He was in AFib in office as well.
PAST MEDICAL HISTORY: Allergies, hyperlipidemia, PAF, CAD requiring stents in
2016, stent to the LAD.
SURGICAL HISTORY: Bladder tumor and prostate.
FAMILY HISTORY: No family illnesses of CAD.
SOCIAL HISTORY: He is a former smoker and does use alcohol occasionally. Does not
use illicit drugs.
ALLERGIES: Denies them.
MEDICATIONS: Claritin, Eliquis, lisinopril, Toprol-XL, Ranexa, Tricor, Zocor.
GENERAL: This patient is awake and alert, answering questions appropriately, not
in acute distress.
VITAL SIGNS: Afebrile, temperature at 98.0, respiratory rate 16, pulse 95, AFib,
blood pressure 141/78, saturating at 95% on room air.
LUNGS: Clear to auscultation. No wheezing or rhonchi present.
HEART: Heart rate is irregular. No murmurs, gallops, or clicks.
ABDOMEN: Slightly distended. There is no abdominal pain. Bowel sounds are
present.
LABORATORY DATA: Potassium 4.1 today, creatinine 0.6, lipase is down to 69 today,
glucose is 174.
IMPRESSION: This is a 77-year-old who presented to the hospital for acute
pancreatitis, who was found to be in AFib and also having chest pain. AFib is
nothing new, has a history of it. We will increase to a home dose of metoprolol
50, and continue on Eliquis. Continue to monitor heart rate. Chest pain is new
that started after starting oral diet. Also, he has not had a bowel movement since
last Friday. We will get troponins and see if any cardiac enzymes are elevated.
Echo and stress test done in office in April, those looked very reassuring. If
troponin is seen to be elevated, we will look into heart cath. This plan was
ABRAM BASINGER
D: **/**/**** 8:12:10 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22684948
CC:
CONSULTATION
CONSULTATION
***************
***************
INDICATION: Paroxysmal atrial fibrillation.
hospital for abdominal pain, found to have elevated lipase and acute pancreatitis.
The patient does have a history of PAF and has been found to be in AFib here in the
hospital. Also overnight, he was having chest pain, midsternal, it was not
radiating anywhere. Morphine was given to help with chest discomfort. This helped
minimally.
The patient has a history of PAF in the past. Current Holter monitor showed AFib
burden to be 37%, currently on Eliquis for blood thinners and metoprolol for rate
control. A stress test and an echo have been done in 04/2021. Stress test showed
no ischemia at that time. Echo showed EF 54%, moderate MI, impaired relaxation,
and diastolic dysfunction.
PAST MEDICAL HISTORY: He has a history of hyperlipidemia and seasonal allergies.
PAST SURGICAL HISTORY: Bladder tumor excision and prostate surgery.
SOCIAL HISTORY: He is a former smoker. Uses alcohol occasionally. No illicit
drug use.
FAMILY HISTORY: No family history of CAD noted.
MEDICATIONS: Claritin, Eliquis, lisinopril, Toprol-XL, Ranexa, Tricor, and Zocor.
acute distress.
VITAL SIGNS: Afebrile, respiratory rate 16, pulse 95, BP 141/78, satting 95% on
room air.
HEART: Heart rate irregular. No murmurs, clicks, or gallops noted.
ABDOMEN: Slightly distended. Bowel sounds are present.
LABORATORY DATA: Potassium 4.1, creatinine 0.6, lipase is down to 69 today, and
glucose 174.
IMPRESSION AND PLAN: This is a 77-year-old male who is being seen for PAF,
currently in AFib. We will adjust medications. Continue on Eliquis, and we will
increase metoprolol to a home dose of 50. Continue to monitor on telemetry. New
onset chest pain. Stress and ultrasound were reassuring in office in 04/2021.
Chest pain could be stemming from pancreatitis and switching to an oral diet. He
has also not had a bowel movement since Friday. We will trend troponins; if
elevated, we will look into having a cardiac catheterization. This plan was
ABRAM BASINGER
D: **/**/**** 8:09:47 T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22684957
CC:
CONSULTATION
CONSULTATION
***************
INDICATION: Shortness of breath.
emergency department with shortness of breath and right leg paresthesia that has
been going on for two weeks. The shortness of breath is seeming to be getting
increasingly worse over these two weeks. She was recently just diagnosed with
paroxysmal atrial fibrillation. This caused her to have lots of anxiety.
Continues to feel pins and needles in the right leg. Also had edema bilaterally.
This with the shortness of breath caused her to come into the emergency department.
This patient was recently seen in the office. Stress and echo were both done at
that time. Echo showed EF 59%, impaired relaxation diastolic dysfunction, mild to
moderate MR. Stress test showed an EF 66%, ESV 26, no ischemia, ETT 7 METs. Also
_____ was performed. This showed one short run of nonsustained VT and five short
runs of PAF. Longest beat was 9 beats. No beta-blocker or no _____ started at
that time. She did start on aspirin.
PREVIOUS MEDICAL HISTORY: Anxiety, ulcer, back pain, degenerative disk disease.
PREVIOUS SURGICAL HISTORY: Epidural injections on lumbar spine, hysterectomy, and
left knee surgery.
SOCIAL HISTORY: Current smoker, half pack per day. Does not use alcohol. Does
not use illicit drugs.
FAMILY HISTORY: There is a family history of CAD.
ALLERGIES: CODEINE.
MEDICATIONS: Omeprazole, Celexa, ibuprofen and aspirin.
GENERAL: This patient is awake and alert, answering questions appropriately
without any acute distress, anxious.
VITAL SIGNS: Blood pressure 124/85, pulse rate 62, normal sinus rhythm, oxygen
levels are 100% on room air, respiratory rate at 16.
HEENT: Head is normocephalic. No trauma. Pupils are equal and reactive to light.
CHEST: Has equal expansion.
HEART: Heart rate regular. No murmurs, gallops or clicks.
ABDOMEN: Soft. Nontender. Bowel sounds present. No guarding.
EXTREMITIES: Bilateral lower extremities, nonpitting edema. Good pulses. No
cyanosis or clubbing noted.
LABORATORY: Labs, troponins are negative. D-dimer is 200. Pro-BNP is not
elevated. Electrolytes are within normal limits. She is not anemic.
IMPRESSION: This is a 61-year-old female who presents to the ER with shortness of
breath and right leg pain. Cardiac testing not favorable in office earlier this
month. Does have history of PAF, was started on aspirin there. CHADS-VASc score
is 2. Today, here in ER, troponins have been negative. Chest x-ray, nonacute. CT
of head, nonacute. Does feel shortness of breath that is satting fine on room air.
I believe lots of patient's symptoms are coming from anxiety. Since the d-dimer is
not elevated, we will not do ultrasound of the leg at this time. If the pain
continues to worsen or redness is noted, we will get one at that time. Stress test
and echo recently done, we will not repeat. We will continue to trend troponin.
If the troponin continues to rise, we will look into doing a heart cath. Plan was
reviewed with Dr. Nazir Ahmed.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22684708
CC:
CONSULTATION
CONSULTATION
***************
CHIEF COMPLAINT: Chest pain.
HISTORY OF PRESENT ILLNESS: This patient is a 66-year-old male who presented to
the ER with chest pain. Chest pain began about two days ago. Chest pain, left
sternal, described as a sharp chest pain. It does not radiate anywhere. Endorses
shortness of breath with the chest pain. EKG reviewed, T-wave inversion noted on
lateral leads. Troponin elevated to 0.122, proBNP also elevated at 4800.
Left heart cath was in 01/2020. At this time left main was patent, circumflex had
mild disease, OM had 80% stenosis noted. LAD had mild disease noted. A small
vessel _____ in the RCA had mid disease 50% stenosis noted. Stent was placed at
the OM at that time.
Last echo showed left ventricular systolic function is low normal. Ejection
fraction is visualized, estimated at 45% to 50%.
Moderate left ventricular hypertrophy.
No evidence of any pericardial effusion.
The patient has multiple risk factors; CAD requiring stents, PVD, diabetes
mellitus, hypertension, CVA in the past and chronic kidney disease.
PAST MEDICAL HISTORY: Acute renal failure, arthritis, asthma, chronic kidney
disease, diabetes mellitus, DVT, GERD, hypertension, PE, pneumonia, CVA.
PAST SURGICAL HISTORY: Colonoscopy; dilation of esophagus; joint replacement; left
leg amputation, below-the-knee.
HOME MEDICATIONS: Propranolol, Percocet, gabapentin, Pletal, Mag-Ox, Lipitor,
Imdur, albuterol inhaler, Plavix, aspirin, sodium bicarb, Lantus, Ranexa, Eliquis,
Keppra, Flomax, ferrous sulfate.
ALLERGIES: The patient has no known allergies.
SOCIAL HISTORY: Tobacco use, he has been smoking, has a 21-and-a-half pack-year
smoking history. Reports no alcohol use.
FAMILY HISTORY: Mother and father both had high blood pressure.
VITAL SIGNS: Blood pressure elevated 175/95, afebrile, pulse 78, respiratory rate
at 15.
GENERAL: Awake, alert, in no acute distress.
HEENT: Normocephalic, atraumatic.
LUNGS: Clear to auscultation bilaterally.
HEART: Regular rate and rhythm. No murmur, clicks, or gallops.
ABDOMEN: Soft. Bowel sounds present. Nontender.
EXTREMITIES: Nonpitting lower extremity edema. Left BKA.
NEUROLOGIC: Grossly intact.
LABORATORY DATA: Troponin elevated at 0.122. BNP 14,822. Creatinine 5.0,
potassium 4.5. Hemoglobin A1c 5.2. Hemoglobin 12.0.
IMPRESSION: This 66-year-old male came in with chest pain, had a history of CAD in
the past. He needs stents. We will continue to trend troponin. If troponins
continued to elevate, he may need heart cath. Echo ordered. If troponins trend
down, we will look into getting stress test. Chronic kidney disease, troponins may
be elevated due to this. We will watch blood pressure throughout the stay and we
will continue to follow patient.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22650144
CC:
CONSULTATION
CONSULTATION
***************
HISTORY OF PRESENT ILLNESS: This is a 60-year-old male who presents to the ER
having chest pain. Chest pain started two days ago. Chest pain is midsternal,
sharp pain that occasionally radiates down the arm. Shortness of breath is often
associated with this. Denies any dizziness or syncope. In the ED, EKG shows sinus
rhythm with incomplete bundle. CTA of the chest to rule out PE. He had an echo
done back in 08/2020, LV function was preserved. The patient had a stress test
done in 06/2020, stress test negative for ischemia at that time.
PAST MEDICAL HISTORY: He has a past medical history of heart catheterization with
acute MI. No stents were placed at that time. He had a pericardial window
effusion and appendectomy.
MEDICATIONS AT HOME: He is on Norvasc, Inderal, and thiamine.
GENERAL: The patient is awake and alert, and answering questions.
VITAL SIGNS: Stable. Blood pressure 125/82, pulse rate 85, normal sinus rhythm on
the monitor.
HEENT: Normocephalic and atraumatic. Pupils are equal and bilaterally reactive to
light.
HEART: Regular rhythm. No gallops or murmurs.
ABDOMEN: Soft, nontender. Bowel sounds are present. No guarding.
LABORATORY DATA: Labs show he is hyponatremic with sodium of 121, potassium 4.2,
creatinine 0.7, magnesium 1.7. Troponin have been negative. ProBNP is 144.1.
Hemoglobin of 13.6. D-dimer elevated at 646.
CTA of the chest not back yet.
IMPRESSION: A 60-year-old male patient who comes into the hospital having chest
pain and shortness of breath, history of pericardial effusion and pericardial
window. Chest pain presented two days ago. Last stress test done a year ago. We
will obtain echo to rule out any new pericardial effusion. We will get CTA of the
chest to rule out PE. We will trend troponins and continue to monitor.
ABRAM BASINGER
D: **/**/**** **:**:** T: **/**/**** **:**:** AB/*******
Job#: ******* Doc#: 22649807
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SPRINGFIELD REGIONAL MEDICAL CENTER

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