Age: 43.0
Sex: M
Vaccine: SMALL
Symptoms: Scan myocardial perfusion, Single photon emission computerised tomogram abnormal, Thyroxine free decreased, Thyroxine normal, Troponin I increased
Clinical narrative: Patient left for a job on 4 Jan 2008 and reports symptoms of "the crud" and being "as sick as a dog". Recalls experiencing nasal congestion and runny nose, as well as generalized body aches and malaise. Does not recall experiencing a fever, chills, cough, sinus pain, N/V/D or headaches. Several members of his department experienced similar symptoms. He did not seek medical evaluation and reports all symptoms, except for malaise, resolved within 3-4 days. The malaise was thought to be related to mission tempo, change in schedule and diet, working 10-12 hour shifts, etc., but has persisted to date. Describes current energy level as 40-60% of his baseline energy level of 100% prior to JAN 2008 job. On 10 Jan 2008, patient reports episode of constant chest pain located in the center of his chest. Describes pain as "wrenching". At the time, patient recalls taking deep breaths to try relax and no change in character or intensity of pain was noted. Denies changes in pain with position changes. Reports pain intensity as 8/10 using pain scale of 0 (=no pain) to 10 (=worst pain ever experienced). Pain radiated to jaw with that episode, but does not always radiate with subsequent episodes. Reports pain lasted about 15 minutes. Denies accompanying symptoms like nausea, diaphoresis, palpitations, dyspnea, or cough. After initial episode, patient has experienced similar episodes about every 4-6 weeks. He reports episodes have never awakened him and never seem to occur when he is "at rest", but usually are associated with mild to moderate exertional activities like mowing yard. Patient first noted being "winded" after about 1 month in theater. Reports that he would become winded after climbing a flight of stairs, which was not his norm. He also noted that he felt winded during the course of a busy day at work. He thought this was unusual because the previous year he had work at high altitudes  and never had problems with his problems with his breathing. He never developed a cough or wheezing. He has been smoking cigarettes since age 14, up until Nov 2011, averaging about 1ppd. He currently notes mild dyspnea with exertion. He reports when he walks up a hill by his home, he often experiences tingling in his fingers about 1/4-way up the estimated 10-15% incline of hill - "always at the same spot". He has had some evaluation of dyspnea through the hospital since he has been out of work. He noted some improvement in overall ease of breathing after having surgery on his deviated septum in 2010. Has had PFTs performed in 2010 and was given albuterol inhaler which he does not use. On 7 NOV 2011, patient sought evaluation for back pain. While in the ER, patient's heart rate was running in the 120's. He denies any change in the character of his ongoing chest pain and dyspnea prior to this evaluation. He denies pedal edema and cough. Patient was admitted for 1 day for observation. ECHO during hospitalization showed EF of 43%. During this hospitalization, metoprolol and lisinopril were initiated. Patient was diagnosed with cardiomyopathy and had a repeat ECHO on 19 MAR 2012 was essentially unchanged - - > cardiac cath showed CAD - - > 4 vessel CABG.