A Brief Note On Coronary Heart Of Diabetic Patients

Abdomen: Obtuse with minimal bowel sounds, slightly distended. There is RLQ (right lower quadrant) tenderness with guarding and with pinpoint rebound. Positive McBurney and obturator signs with a negative psoas sign.

was awakened from her sleep by sharp left sided chest pain. The pain worsened with motion and

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Patient is a high school counselor. He participates in physical activities by running 2 to 3 times a week, playing golf, and volunteering at a nursing home. The patient is married with one daughter and one son. He does not use tobacco and periodically drinks at

Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

History of cardiomyopathy. The most recent echocardiogram was done in 2014 showing improved ejection fraction at 55%. He feels asymptomatic, at this time. He did have recent testing with Dr. Dourdoufis. I will request those notes and review them when they arrive. He will certainly let myself or Dr. Dourdoufis know or seek care if necessary if his symptoms change acutely.

Jim presented to Camberra Hospital almost one months ago with symptoms of right-sided anterolateral chest pain lasting a couple of days, a dry cough and breathlessness.

He also had a history of shortness of breath for several months (2014). He was evaluated by the cardiologist; the test results indicated that the heart was not causing the shortness of breath. Later he was referred to a lung specialist for further evaluation.

Even when these patients are brought in exhibiting these symptoms, due to the rarity of Uhl’s anomaly, all other possibilities are researched first. Often after echocardiography, chest x-rays, and EKG’s are done, and treatment is administered, there is usually minimal or no

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

A 75-year-old woman with acute bronchitis ruled out pneumonia and had no other specific symptoms. The purpose of this exam was to that it was demonstrated that the patient had acute bronchitis. Initially looking at the image, it appeared as if the patient had situs inversus of her heart. The patient also exhibits a large diaphragmatic hernia on the left side of her lung field which has caused the heart and mediastinum to shift to the right side. However, when we investigated into the patient's past medical history and she has had this diaphragmatic hernia for a considerable length of time which caused the appearance of her heart to be on the right side instead of the left.

Cardiac: Regular rhythm without murmur, normal S1and S2. One plus edema to bilateral lower extremities. Capillary refills are presents and carotid bruits are absent.