HISTORY OF PRESENT ILLNESS: The patient is a 55-year-old African American, who speaks French and Chinese, presenting with a chief complain of chest pain. He has been having mild chest pain since early autumn, but it has been increasing recently, especially over the holidays. He has been taking Dyazide for blood pressure and also uses ibuprofen occasionally. On Sunday, New Year’s Day, he called his insurance company and was referred to South Side Hospital. The patient presented to the emergency department for evaluation and was noted to have T-wave inversions on his ECG. Chest x-ray showed no pneumonia or pulmonary edema. He was given nitroglycerin sublingually x2, with resolution of his chest pain. CPK was shown to be elevated and cardiology was called to evaluate this patient and assume his care. The patient was admitted to the Intensive Care Unit at 0300. PAST MEDICAL HISTORY: The patient has a diagnosis of early Parkinson Disease and is treated by a neurologist for this.
ALLERGIES: The patient is allergic to SULFA which causes hives.
PHYSICAL EXAMINATION: VITAL SIGNS: blood pressure 110/95, pulse 75, respirations 18. HEENT: Normocephalic,, atraumatic, pupils equal, round, reactive to light and accommodation. Fundi clear, no AV nicking. Ears, nose and throat clear. NECK: Supple, no JVD, no lymphadenopathy. THORAX AND LUNGS: Clear to percussion and auscultation. CARDIOVASCULAR: s1 and s2 normal. There was a grade 2/6 systolic ejection murmur. ABDOMEN: Supple. No organomegaly or rebound tenderness. ANO-RECTAL: Deferred. EXTREMITIES: No clubbing, cyanosis, or edema.
HOSPITAL COURSE: The patient was taken to the cardiac catherization laboratory on the morning of admission. This study revealed no areas of stenosis of the coronary arterial system. The patient was given nitroclycerin sublingually p.r.n. chest pain and was given Procardia for his hypertension. His ECG normalized and on Tuesday he was subjected to a treadmill exercise test...