tokens: 825330116 HLGMC 6051380 10615/2646 8/15/1993 12:00:00 AM ACUTE MYOCARDIAL INFARCTION . Unsigned DIS Report Status : Unsigned ADMISSION DATE : 8-15-93 DISCHARGE DATE : 08-22-93 PRINCIPAL DIAGNOSIS : Acute myocardial infarction . ASSOCIATED DIAGNOSIS : 1. Coronary artery disease , 2. unstable angina ( postmyocardial infarction angina ) , 3. Parkinson &apos;s disease . SPECIAL PROCEDURES AND OPERATIONS : 1. Percutaneous transluminal coronary angioplasty and coronary atherectomy of the left anterior descending , 8-17-93 , 2. relook coronary angiogram , 08-18-93 . DOCTORS DISCHARGE ORDERS AND MEDICATIONS ON DISCHARGE : Ecotrin 1 tablet PO qd , Captopril 6.25 mg PO tid , K-Dur 20 mEq. PO qd , Lasix 20 mg PO qd , Isordil 10 mg PO tid , Sinemet 1/2 tablet PO bid , Symmetrel 100 mg PO bid , Parloder 2.5mg PO qd . HISTORY OF PRESENT ILLNESS : The patient is a 58 year old female with a history of Parkinson &apos;s disease for more than twenty years who presented to the Gemenadentoolpai Medical Center with a revolving anterolateral wall myocardial infarction on 08-01-93 . She has been under the care of Dr. Aalv Manual and was referred here for further therapy . She had no prior significant cardiac history and presented to her local medical doctor &apos;s office with an episode of severe retrosternal chest pain . Her electrocardiogram showed a new right bundle branch block and left anterior hemiblock . The patient was transferred to the Gemenadentoolpai Medical Center and was admitted . Her hospital course was remarkable for ruling in for a myocardial infarction with a peak CPK of 9,379 units with a 5.9% MB fraction . In addition , on telemetry she developed complete heart block and hypotension requiring temporary pacing wire and then a permanent pacemaker implantation on 08-03-93 . She developed congestive heart failure and required pressor support . She underwent cardiac catheterization on 8-15-93 and was found to have a left ventricular end diastolic pressure of 28 millimeters of mercury . She had a dominant right coronary artery with minor disease . The main left coronary artery had a 20% stenosis . The left anterior descending had a severe 80% proximal stenosis with a filling defect consistent with intraluminal thrombus . The circumflex artery had a minor 40% stenosis . Cine left ventriculogram revealed a dilated left ventricle with an area of anterolateral , apical , and septal akinesis . The left ventricular ejection fraction was estimated to 38% . The patient was transferred to the Heaonboburg Linpack Grant Medical Center for consideration of coronary angioplasty . CARDIAC RISK FACTORS : Her risk factors for coronary artery disease included a positive family history and an elevated cholesterol level . PAST MEDICAL HISTORY : Her past medical history is remarkable for a history of Parkinson &apos;s disease . PHYSICAL EXAMINATION : Her physical examination at the time of admission revealed a pleasant lady in no acute distress . The blood pressure was 120/70 millimeters of mercury . Her pulse was regular at 80 beats per minute . The jugular venous pressure was elevated at 6 cm above the sternal angle . The carotids were normal . The chest was clear . The cardiac examination revealed anapical impulse in the fifth left intercostal space , left to mid clavicular line . The first sound was normal . The second sound was normally split . She had no murmurs and no gallops . The examination the abdomen was benign . The examination of the extremities showed no edema . She had good pulses bilaterally . LABORATORY DATA : Her electrocardiogram revealed normal sinus rhythm , left atrial enlargement , left axis deviation , poor R-wave progression in V1 through V4 , consistent with marked clockwise rotation , cannot rule out an old anteroseptal wall myocardial infarction . There were prominent Q-waves in AVL , consistent with lateral myocardial infarction . There were non-specific ST-T wave abnormalities . HOSPITAL COURSE : The patient was admitted to the Medical Service . The patient was seen in consultation by the Neurology Department because of the history of Parkinson &apos;s disease . The patient was maintained on intravenous heparin . On 8-17-93 , she was taken to the cardiac catheterization laboratory where she underwent percutaneous transluminal coronary angioplasty of the proximal left anterior descending . Following balloon angioplasty , there was a local dissection with evidence of intraluminal thrombus , with a greater than 10% loss in the initial gain following coronary angioplasty . Therefore , directional coronary atherectomy was performed with an excellent angiographic outcome , and a less than 10% residual narrowing . The patient tolerated the procedure well . She was maintained on intravenous heparin and was brought back to the cardiac catheterization laboratory on 08-18-93 for a relook coronary angiography . Coronary angiography demonstrated ongoing benefit of the initial coronary atherectomy . Specifically , there was no decrease in the initial gain that she achieved after directional atherectomy . The patient remained stable during the rest of the hospitalization . She was transferred in stable condition to the Pasi for further rehabilitation therapy . RENLAN FYFEZEIS , M.D. Dr. Aalv Lorjes Salv Manual Pasi TR : jb / bmot DD : 9-17-93 TD : 09/19/93 CC :