tokens: Admission Date : 2015-06-04 Discharge Date : 2015-06-08 Date of Birth : 1958-03-17 Sex : F Service : CCU HISTORY OF THE PRESENT ILLNESS : The patient is a 57 - year-old female with a history of hypertension and hypercholesterolemia but no prior coronary artery disease history who presented with chest pain . The patient reports the pain began at 4:00 p.m. on the day of admission . She reports that it had essentially started earlier in the day with some GERD-like symptoms . She had taken Maalox but had no relief with this . The pain was intermittent through the day and then at 4:00 p.m. increased and was also associated with nausea and diaphoresis . She reports that the pain shot through her back . The patient has never had these symptoms in the past . She arrived in the Emergency Room at 8:00 p.m. At that time , the pain was unremitting . In the Emergency Room , the patient was given Lopressor , nitroglycerin , and aspirin . A TP3A inhibitor was not given for concern for dissection . The patient was found to have 5057 E. Sixth Blvd. elevations in I , aVL , and V1 through V2 and ST depressions in II , III , and aVF . The patient was taken emergently to the Cardiac Catheterization Laboratory . PAST MEDICAL HISTORY : 1. Hypertension . 2. Hypercholesterolemia . 3. Chondrocalcinosis . 4. Carpal tunnel syndrome . 5. GERD . ADMISSION MEDICATIONS : 1. Atenolol 25 . 2. Crestor 10 q.d. 3. Uniretic 15/25 . ALLERGIES : The patient has no known drug allergies . SOCIAL HISTORY : The patient denied tobacco . The patient denied alcohol or other drug use . PHYSICAL EXAMINATION : Vital signs : On admission , the patient was afebrile , blood pressure 146/88 , pulse 71 , respirations 18 . General : The patient was a well appearing female in no acute distress . Cardiac : Regular rate and rhythm , normal S1 , S2 . No murmurs were appreciated . Lungs : Clear to auscultation bilaterally . Abdomen : Soft , nontender , nondistended , good bowel sounds . Extremities : There was no edema in the extremities . The dorsalis pedis pulses were 2+ bilaterally . LABORATORY AND RADIOLOGIC DATA : On admission , white count 10.8 , hematocrit 38.2 , platelets 324,000 . HOSPITAL COURSE : 1. CORONARY ARTERY DISEASE : The patient was taken to Cardiac Catheterization where she was found to have two vessel disease . The proximal LAD was found to have a 90% lesion with a septal branch with a 95% stenosis and a diagonal branch with 99% stenosis . The patient had twin LAD stents to the LAD diagonal and LAD septal branches with Taxus stents . This restored flow appropriately . The patient also had proximal RCA lesion of 80% and a mid RCA lesion of 80-90% which were not intervened upon . The patient was given an aspirin and Plavix and in addition started on a beta Elmore , Maxine ACE inhibitor , and these were titrated up as her blood pressure tolerated . Given the fact that the patient had issues with muscle cramping with Atorvastatin in the past , she was started on Pravastatin which should give less of these side effects . The patient will follow-up with Cardiology in one months time for further management of her coronary artery disease and further evaluation of her remaining RCA lesions . 2. PUMP : The patient had an echocardiogram to assess her LV function . She was found to have an ejection fraction of 30-35% as well as an akinetic apex and apical mid and septal akinesis . Given the fact that the patient had significant apical akinesis , she was started on heparin with a transition to Coumadin for anticoagulation for stroke prevention in the setting of apical akinesis . On discharge , the patient was given Lovenox injections which should be continued until the patient reaches a therapeutic dose of Coumadin . 3. RHYTHM : The patient was monitored on telemetry throughout her hospitalization with no significant events . The patient had an EP evaluation and will be followed-up by Dr. Welch . 14-087 , the patient had a signal-averaged EKG . She will follow-up with Dr. Welch with an echocardiogram on 2015-07-24 in a meeting to discuss risk stratification for sudden cardiac death and possible ICD placement . 4. NEUROLOGY : The patient complained of left lower extremity weakness with ambulation two days after her cardiac catheterization . The patient had no evidence for weakness on examination with good proximal and distal strength in the lower extremities as well as intact sensation . The patient worked with Physical Therapy and was able to ambulate without difficulty . She was also able to ascend stairs without difficulty . The patient was already on an aspirin and Plavix should this represent a small stroke . However , there was no evidence for neurologic deficit on examination and this will be followed-up by her primary care physician . 5. HEMATOLOGY : The patient was discharged on Coumadin for apical akinesis and stroke risk . This will be further monitored by her primary care physician , Dr. Banks , who will adjust her Coumadin dose . CONDITION ON DISCHARGE : Stable . DISCHARGE STATUS : To home . DISCHARGE DIAGNOSIS : ST elevation myocardial infarction , status post left anterior descending artery stent . DISCHARGE MEDICATIONS : 1. Aspirin 325 q.d. 2. Lisinopril 5 q.d. 3. Toprol XL 100 q.d. 4. Coumadin 5 q.d. 5. Plavix 75 q.d. 6. Lovenox 60 mg b.i.d. until therapeutic on Coumadin . 7. Pravastatin 80 q.d. FOLLOW-UP PLANS : The patient will follow-up with her primary care physician in the week following discharge for further monitoring of her INR and adjustment of her Coumadin dose . The patient will also follow-up with Electrophysiology with Dr. Welch on 2015-07-24 . In addition to this , the patient will follow-up with Cardiology , Dr. Foster , and Dr. Upshaw , on 2015-07-06 for further monitoring . Joshua PINTO , M.D. 12.932 Dictated By : Greg E. Riordan , M.D. MEDQUIST36 D : 2015-06-10 09:17 T : 2015-06-12 16:28 JOB #: 74717 Signed electronically by : DR. David PINTO on : FRI 2015-06-19 5:36 PM ( End of Report )