text:  1  Cardiovascular  The patient was admitted for rule out myocardial infarction . She remained on telemetry for greater than 48 hours which demonstrated no dysrhythmia during this time . The patient underwent an echocardiogram which demonstrated a preserved ejection fraction with left ventricular hypertrophy and no significant valvular abnormalities . The patient was maintained on her aspirin and Lasix . The patient &aposs Diltiazem was stopped due to her increased blood pressure and was started on Labetalol which was gradually titrated up to a target blood pressure of 160-170 systolic in her right arm . The patient also underwent an Adenosine MIBI stress test which showed only mild lateral ischemia . At this time   the patient &aposs presyncopal symptoms were not felt to be secondary to a cardiovascular etiology . 2  Neurological    vascular  The discrepancy in the patient &aposs pulses and blood pressure was felt to be consistent with a subclavian artery stenosis . The patient underwent MRI    MRA of the head   neck and upper chest which demonstrated a proximal left subclavian artery stenosis   proximal to the take off of the left vertebral artery . The left vertebral artery had a decreased flow consistent with either native vessel disease or some degree of retrograde flow with subclavian steal phenomenon . The patient had patent carotids bilaterally on her neck MRA . MRI of the head demonstrated a small vessel disease and was likely an old right cerebellar infarct . The patient underwent non-invasive carotid ultrasounds which demonstrated no significant carotid disease . The patient was also noted to have antegrade flow in both of her vertebral arteries bilaterally . The results of these studies suggested that the patient &aposs symptoms were not due to subclavian steal phenomenon   and therefore   it was decided that the patient would not go further to angio and    or surgical or percutaneous intervention . A Neurology consult was obtained and it was felt that the most valuable intervention that could be done for the patient &aposs intervascular disease would be adequate control of her blood pressure . 3  Orthopedic The patient suffered a fall at home with her initial event . Outside hip films were obtained   but were not available for view . Repeat hip films demonstrated a right sided pubic rami fracture   likely new . An Orthopedics consult was obtained and the patient was encouraged to weight bear as tolerated with Physical Therapy assistance . A bone scan was also obtained to rule out an occult hip fracture which was negative . At the time of this dictation   the patient was able to bear weight with the assistance of Physical Therapy and a walker .Plan