Beneficiary's Medical Profile: A Case Study

BH was referred to a cardiologist in May, 2015 for complaints of chest pain. He denies chest pain or tightness at present.

HPI: Margaret Elliot is a 52-year-old Caucasian female that is presenting with shortness of breath that has recently worsen. Mrs. Elliot states that her problems began 20 years ago when she had bronchitis, which she consistently has 2-3 times a year. She said that her symptoms have been getting worse the last 2.5 month, but have severely worsen over the past three days. She states that it has been restricting her daily activities and has been troubling her while sleeping lying down. She states that her symptoms improve alittle when she takes her medications. She also states that her symptoms worsen when she tries to walk across the room

He reported that he had a cardiac cath done at Tampa General Hospital this year with no intervention. He has had a history of hypertension since the age of 19. He was not adherent to medications, but for the last three years, he has been adherent to all his medical care. No history of stroke or peripheral vascular

No information is given to determine previous medical history, so all possible causes can be taken into consideration related to F.T’s shortness of breath. A history of Chronic Obstructive Pulmonary Disease could contribute to this acute episode of shortness of breath, and warrants further assessment due to the risk of Cor Pulmonale associated with COPD. The indication of his increased use of an albuterol inhaler also leads me to believe that he has a previous pulmonary complication, which could be likely be COPD, or possibly Asthma as the medication is

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

c. 34 years old male who complained of shortness of breath. He was obese and had a history of COPD. He was on two liters nasal cannula. After admitting at the ER, he was tranfered to med-surge floor for further evaluation.

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

On Tuesday August 30, 2016 a Male 63 years of age came into Christus Spohn South Heath Center with a diagnostic order for chest and rib x-rays. He was being seen because of chest pain on his right side due to a fall. He had an extensive patient history of x-rays that went as far back as 2014. For the year of 2016 he received approximately 12 different x-ray series. For example, on January 12, 2016 he received a chest 1 view image and cardiac catheterization. On May 21, 2016 he received a chest 1 view and a complete 4 view foot. On May 30, 2016 he received a cardiac catheterization. On June 1, 2016 and again on June 2, 2016 he received a chest 1 view. On June 10, 2016 he received a catheterization. On August 25, 2016 he received a chest 2 view. On August 26, 2006 an upper extremity without contrast. The patient also has a history of open heart surgery and receives dialysis treatments and is on oxygen.

The last visit I had with the patient on June 7th, I elected to start him on antihypertensive therapy. He was given a prescription for Zestoretic 10/12.5 mg one p.o. to take daily. He says that he did take one as recommended. That same day in the afternoon, he noted that he was short of breath in the afternoon. He says that he attributed it to the work that he was doing out in the yard and later that day, it seemed to resolve. A few days later, he had the same thing happen again. He eventually went on to see Dr. Lilly on June 25th. Please see that note for complete details. She did have him go through a series of testing, including laboratory studies, which were normal

His lung sounds are diminished bilaterally. Pulse oximetry reading is 90%. He is receiving oxygen at 2 liters per nasal cannula. He complains of shortness of breath with exertion.

Michael was seen today following his HRCT scan of his chest and lung function tests. The HRCT showed mild emphysema and an incidentally noted 4mm right middle lobe pulmonary nodule. There was the incidental finding of an aneurysm or dilatation of the celiac axis and probably the common hepatic artery, though this wasn't completely imaged. We were hoping for an echocardiogram, though he is on the wait list for this to happen at the Austin Hospital.

The patient is a 74-year-old female who was brought to the emergency room by BLS when she awakened from sleep with severe shortness of breath. In transit she received sublingual Nitroglycerin note to supplementation as well as a nebulizer. When seen in the ED she was placed on BiPAP and nebulizer for approximately an hour. It is to be noted the patient has severe COPD and pulmonary hypertension. She does have coronary disease as well. It is to be noted that she is on Citrucel for her pulmonary hypertension. There are no blood gases done, however on BiPAP her O2 sats were 99%. Chest x-ray shows soft tissue mass I believe in the right upper lobe. I believe that this patient in view of her significant history of comorbidities and severe

Mr. Heart, a 72-year-old male admitted for an elective open heart procedure has the following medical and surgical history: coronary heart disease; arthritis; hypothyroidism; diet controlled diabetes; underwent appendectomy; arthroscopic right knee surgery; and two cardiac stents. No history of smoking and weights 160 lbs. at 5’ 11”.

Myocardial Perfusion Imaging is also known as (MPI). It is an imaging modality used in nuclear medicine to demonstrate the heart muscle functions; a low dose of radioactive agent is used for this study called a radiotracer. There are two different types of techniques used for myocardial perfusion imaging. The first is, single photon emission computed tomography (SPECT) and the second, positron emission tomography (PET). Myocardial perfusion imaging is commonly done for patients whose experience some type of chest discomfort, a recent myocardial infarction, or it may be used to access the blood flow to the myocardium that has been restored by bypass, stent or angioplasty. It can also be used to diagnose coronary artery disease. According to

Myocardial Perfusion Imaging also known as MPI is an imaging modality used in nuclear medicine to demonstrate the heart muscle functions; a low dose of radioactive agent is used for this study usually technetium -99m based radiotracer. There are two different types of techniques used for myocardial perfusion imaging, single photon emission computed tomography (SPECT) and positron emission tomography (PET). Myocardial perfusion imaging is usually done for patients who experience some type of chest discomfort, recent myocardial infarction, or to access the blood flow to the myocardium that has been restored by bypass, stent or angioplasty. And it can be used to diagnose coronary artery disease. According to Kostkiewicz (2015) “the best candidates for Myocardial Perfusion Imaging also known as (MPI) are people with poor exercise, ECG abnormalities, and pretest likelihood of disease according to the ECS guidelines” (p. 2). This modality is able to assess the severity of coronary obstruction and the extent of it; it’s also able to localize hemodynamically the importance of stenosis.