[doctor] hi evelyn , how are you ?
[patient] i'm good , how are you ?
[doctor] i'm good . it's good to see you .
[patient] good to see you too .
[doctor] so i know the nurse told you a little bit about dax . i'm gon na tell dax about you , okay ?
[patient] okay .
[doctor] so evelyn is a 56-year-old female with a past medical history significant for coronary artery disease , prior carpal tunnel release , and a herniated disc who presents for her annual exam . so evelyn it's been a little while since i've seen you , how have you been doing over the last year ?
[patient] i've been doing okay , um , everything , um , with my herniated disc in my back has been doing really well . i have n't had any , um , back pain , or any , um , limitations in movement , so that's been doing well .
[doctor] okay , yeah , i know that we have done a steroid injection for that , uh , a couple of month- , uh , several months ago , so that's- that's doing well ?
[patient] yeah , it is .
[doctor] okay , i'm glad to hear that . and then , how about your carpal tunnel issues , you had that fixed a couple of years ago , so are you having any recurrent issues , or you good , you back to work ?
[patient] i am back to work . i have n't had any issues , and i've had full range of motion , and it's- it feels really good .
[doctor] all right , so no numbing and tingling in your hands ?
[patient] no .
[doctor] okay , that's good . and then , you know , i know that you've had , uh , prior stenting in the past for your- for your heart , and your heart vessels .
[patient] mm-hmm .
[doctor] how are you doing from that standpoint ? have you had any chest pain , shortness of breath , nausea or vomiting ?
[patient] over the last month i've been having a bit of chest pain , but i have n't had any of the other symptoms you mentioned .
[doctor] okay , does the chest pain happen when you walk ?
[patient] yeah , it does .
[doctor] okay , and does it- does it go away if you- if you rest ?
[patient] yeah , it does actually .
[doctor] okay , all right . do you ever get it just sitting there at rest ?
[patient] no i do n't .
[doctor] okay , all right . okay , and- and can you describe it ?
[patient] it's like a burn .
[doctor] okay .
[patient] it it just feels like it's burning , um , nothing terribly concerning , not enough to send me to the er , but i do notice it .
[doctor] okay , and where exactly is it located in your chest ?
[patient] just , um , right in the middle ...
[doctor] okay .
[patient] right here .
[doctor] okay . and how often are you getting it ?
[patient] um , probably about three- three times a week .
[doctor] okay , all right . well i'm glad that you talked about that with me today , um , i know the nurse did a review of systems sheet with you , and , you know , you're obviously endorsing this- this chest pressure . um , have you had any other symptoms , i know the- the other ones that you have n't had , but any lower extremity edema , or muscle aches , or fever chills ?
[patient] no , nothing like that , but i have had a little bit of congestion , um , just from allergies , because of the pollen .
[doctor] okay , so you're endorsing some nasal congestion ?
[patient] yeah .
[doctor] all right , well let's go ahead and we'll do a physical exam , okay ?
[patient] okay .
[doctor] hey dragon ? show me the vital signs . so here your vital signs look really good , i'm- i'm happy to see that your blood pressure is under- under good control , and your oxygenation is fine , so i'm just gon na take a listen to your heart and lungs , and i'll let you know if i find anything , okay ?
[patient] okay .
[doctor] okay , so in physical exam your heart has a slight three out of six systolic ejection murmur , which we've heard before . your lungs are nice and clear , uh , i do n't appreciate any carotid bruits , and- and you have no lower extremity edema , you have healed , uh , surgical scars on your- on your , uh , right wrist . um , so let's go ahead , i wan na look at some of your results , okay ?
[patient] okay .
[doctor] hey dragon , show me the echocardiogram ? so this is the echocardiogram from last year , you know , you did have a slightly low pumping function of your heart at 45 % , but , uh , i- , you know , i suspected that will improve over time , and you did have some slight , what we call , mitral regurgitation , that's just a leaky heart valve , and that's that murmur that i heard . hey dragon , show me the ecg ? and here , you know , in reviewing your results of your e- ecg , you know , it looks stable , it just kinda reflects your prior coronary artery disease . there's no new changes , which is good , so let's talk a little bit about my assessment and plan for you .
[doctor] so , from your first problem , you know , your carpal tunnel release , i do n't think that we need to anything further about that , 'cause you seem to be doing really well , you're back at work , if you have any recurring symptoms , just let me know , and we can take it from there . for your next problem , your herniated disc , that also sounds like your doing really well , i do n't think that we need to refer you for any further steroid injection , or physical therapy at this time . so , if you have recurrent symptoms , i want you to let me know . and finally , your last problem , the most concerning problem to me is your known coronary artery disease , and this recurrent chest pain you have .
[doctor] so , i wan na go ahead and continue you on your asprin , and your toprol , okay ? i wan na go ahead and order a stress test for you to see if you have more blockages that could be causing this chest discomfort , okay ?
[patient] okay .
[doctor] and i'm gon na go ahead and get a lipid panel and , uh , start you on crestor 20 mg , once a day , okay ?
[patient] okay .
[doctor] hey dragon , order a cardiac stress test . do you have any questions ?
[patient] no , that's it .
[doctor] okay , all right . hey dragon , finalize the note . so , it was good to see you , the nurse will come in , she'll help you get your scheduled for all of those things , and i'll be in touch , okay ?
[patient] okay .
[doctor] take care .

Medical orders:
description: lipid panel
order_type: lab
reason: coronary artery disease
description: crestor 20 mg once a day
order_type: medication
reason: coronary artery disease