Thrombotic Microangiopathy

presented with chest pain and an exacerbation of chronic iron deficiency anemia. The patient was examined and given a chest x-ray along with and ECG to assess heart function. The patient complained of shortness of breath and a tight feeling in his chest when he was breathing. The patient has history is sick sinus syndrome, therefore the patient was aware of the symptoms and has felt them before. The patient’s medical history also includes obesity, hypertensive heart disease, A-Fib, CAD, venous stasis ulcers, and a history of EtOH abuse. The patient presented with +1 pitting edema in the lower extremities, with a cool temperature symmetrically. The patient’s capillary refill was less than 3 seconds with Dorsalis pedis pulses +1 and Posterior tibialis pulses +1 symmetrically. The patient’s vital signs were BP-112/69, RR-20, P-70, T-36.2 degrees C and SpO2 94% on room air. The patient’s white blood cell count was within normal limits, therefore an infection is not suspected. The patient’s BMI was 35, therefore considering him obese. Since the patient presented with chest pain, the patient was given a medication to control his heart rhythm and

The patient has no family history of heart disease or diabetes, however both her parents are on medication for high blood pressure. Her paternal grandmother died of breast cancer at age 47. Her maternal grandmother

The patient tells me his last visit with Peter Dourdoufis, MD was just last week. I do not yet have a note from that visit. He says that he underwent an EKG and a stress test evaluation. To his knowledge, everything was okay, but he actually has an appointment tomorrow with Dr. Dourdoufis to review everything. No medication changes have been made per his report. He tells me that his blood pressures have been in a good range. Here today, his blood pressure is 126/76. He is not having problems with chest pain, shortness of breath, dyspnea on exertion or lower extremity swelling. He is still working

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

“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.”

A visit note from Renu Mehta, MD (Family Medicine), dated 08/02/2017, indicated that the claimant presented with complaints of lower extremity pain and stomach pain. She continued to have abdominal discomfort. She had a history of hematuria and continued to have a 1+ blood. Objective findings showed a BMI of 31.89 with a blood pressure of 105/72. She was diagnosed with an abdominal pain and hematuria. A series of laboratory tests were recommended.

As mentioned, the patient’s name is Joshua John Laurane. He is an African American male of 69 years with a past medical history of diabetes (Type II), hypertension, congestive heart failure, and high cholesterol. He first presented with these underlying

The patient is a 75-year-old female who did see a new pulmonologist (Daniel Kim, DO) as Elvira Aguila, MD left this area. She did have a CT scan done of her lungs. She was told to hold her metformin and had blood work done because of IV contrast. Her creatinine did go up to a high of 1.5, but then on repeat came back to 1.37 with a BUN of 14. I did have her decrease her dose of metformin from 1000 mg b.i.d. to 500 mg b.i.d. She did have a BUN and creatinine done in December of 2014, which showed creatinine of 1.46, BUN of 35. Repeat in March of 2015 showed creatinine of 1.1 with a BUN of 49. The patient has also been found to have proteinuria with a urine microalbuminuria/creatinine

Mr. Bishop is here for routine followup of his chronic illness. He is treated with Alvesco 160 mcg two puffs twice daily, Atrovent two puffs three times daily and Ventolin as needed for his COPD. He reports good compliance and uses these inhalers as prescribed. He generally uses his Ventolin with exercise. He reports that he is running 1-2 miles a day and also doing a step tape daily and reports good exercise tolerance. He does not wake at night coughing or feeling short of breath. For his hypertension, he takes hydrochlorothiazide 25 mg, and amlodipine 5 mg, and simvastatin 20 mg for his hyperlipidemia. He takes these as prescribed and denies any side effects. He denies

Mrs. P is a 63-year-old female who was not feeling well for a couple of weeks. She went to her Primary Care Physician (PCP) complaining of increased dyspnea on exertion, weakness, nausea, headaches, loss of appetite and periods of confusion. Since she has an extensive medical history that included pulmonary hypertension and emphysema, blood work was obtained. She was told that she had leukocytosis, hyponatremia (Sodium 126 mEq/L ), hypokalemia (Potassium 2.5 mEq/L) and an acute kidney injury (AKI). She was told to go to the emergency room and was admitted to the telemetry unit.

The patient is a 53-year-old African American female who was recently hospitalized from 1/19 -1/22, had a complete workup for seizure disorder, was discharged home and she represented to the ED several times on the 23rd complaining of seizures. She present after having a single isolated seizure which lasted 20 minutes witnessed by her family. She also presented earlier in the evening of the previous evening because she continued to have seizures. She is a history of CVA, hypertension, bipolar disorder. The patient has required intubation in the past. Her laboratory work is essentially unremarkable, phosphatase of 26, AST of 72 and ALT of 75. Dilantin levels are not reported at this point. The case was discussed with Dr. Amr Kahf. I

A was admitted to the Medical Telemetry Unit of the hospital secondary to possible myocardial infarction and syncope. During the course of hospitalization, he received IV labetalol for his blood pressure and was placed on subcutaneous insulin sliding scale for his diabetes. Pharmacological stress test revealed left ventricle was dilated with reduced systolic function and global hypokinesis. These findings are consistent with non-ischemic cardiomyopathy. Echo was obtained and showed decreased EF of 30%, an elevated central venous pressure of 15 mmHg and an elevated pulmonary artery pressure of 78 mmHg. Due to his end stage renal disease, Nephrology was consulted and recommended to continue his dialysis three times per week as scheduled. He was discharged after there were no further episodes of syncope and has been asymptomatic. Atenolol and Clonidine were prescribed, as these are the only medications he will be able to get at a reasonable

The patient is a 52-year-old gentleman who did restart his lisinopril/hydrochlorothiazide, which he had run out of previously. He continues on his amlodipine 10 mg one p.o. daily. He tolerates these medications well. He does have a history of nephrolithiasis. His blood pressure has been well controlled at home.

A relatively uncommon disorder, autoimmune hemolytic anaemia (AIHA) has a prevalence of 17:100,000. Warm Autoimmune hemolytic anaemia (wAIHA) is a form of AIHA, where autoantibodies cause damage to the outer membrane of the red blood cell, via antigens, triggering the immunologic premature phagocytosis/death (haemolysis) of red blood cells. When the mortality rate of RBCs surpasses the capacity of the bone marrow to deliver more RBCs, anaemia occurs. In which case the following symptoms manifest in patients:

The patient has high blood pressure because the kidneys are not functioning properly to remove the liquid portion of the blood, thus increasing blood volume which increases blood pressure. Her ECG waveform displayed a peaked T-wave, depressed ST segment and a weak P-Wave because of her increased serum potassium levels. Increased serum potassium levels almost immediately cause irregularities within the heart. This is consistent with the diagnosis of