[doctor] hi , roger . how are you ?
[patient] hey . good to see you .
[doctor] good to see you . are you ready to get started ?
[patient] yes , i am .
[doctor] roger is a 62 year old male here for emergency room follow-up for some chest pain . so , roger , i heard you went to the er for some chest discomfort .
[patient] yeah . we were doing a bunch of yard work and it was really hot over the weekend and i was short of breath and i felt a little chest pain for probably about an hour or so . so , i got a little nervous about that .
[doctor] okay . and had you ever had that before ?
[patient] no , i never have , actually .
[doctor] okay . and-
[patient] whose mic is on ? i'm in .
[doctor] okay . and , um , how are you feeling since then ?
[patient] um , after , uh , we were done , i felt fine ever since , but i thought it was worth looking into .
[doctor] okay . and no other symptoms since then ?
[patient] no .
[doctor] okay . and any family history of any heart disease ?
[patient] uh , no , actually . not , not on my , uh , uh , on my immediate family , but i have on my cousin's side of the family .
[doctor] okay . all right . all right . and , um , you know , i know that you had had the , uh , knee surgery-
[patient] mm-hmm .
[doctor] a couple months ago . you've been feeling well since then ?
[patient] yeah . no problem in , uh , rehab and recovery .
[doctor] okay . and no chest pain while you were , you know , doing exercises in pt for your knee ?
[patient] no . that's why last week's episode was so surprising .
[doctor] okay . all right . and in terms of your high blood pressure , do you know when you had the chest pain if your blood pressure was very high ? did they say anything in the emergency room ?
[patient] um , they were a little concerned about it , but , uh , they kept me there for a few hours and it seemed to regulate after effect . so , it , it did n't seem to be a problem when i , when i went home .
[doctor] okay . and , and i see here that it was about 180 over 95 when you went into the emergency room . has it been running that high ?
[patient] uh , usually no . that's why it was so surprising .
[doctor] okay . all right . all right . well , let's go ahead and we'll do a quick physical exam . so , looking at you , you know , i'm feeling your neck . i do feel a little enlarged thyroid here that's not tender . you have a carotid bruit on the right hand side and , uh , your lungs are clear . your heart is in a regular rate and rhythm , but i do hear a three out of six systolic ejection murmur . your abdomen is nice and soft . uh , there is the healed scar on your right knee from your prior knee surgery , and there's no lower extremity edema .
[doctor] so , let's look at some of your results , okay ?
[patient] mm-hmm .
[doctor] hey , dragon , show me the blood pressure . yeah . and here , your blood pressure's still high , so we'll have to talk about that . um , hey , dragon , show me the ekg . so , here you- that's good , your , your ekg-
[patient] mm-hmm .
[doctor] . here is normal , so that's , that's very encouraging . um , i know that they had the echocardiogram , so let's look at that . hey , dragon , show me the echocardiogram . okay . so , looking at this , you know , you do have a little bit of a , a low pumping function of your heart , which , you , you know , can happen and we'll have to look into that , okay ?
[patient] mm-hmm .
[doctor] so , you know , my impression is is that you have this episode of chest pain , um , that could be related to severe hypertension or it could be related to some heart disease . so , what i'd like to go ahead and do is , number one , we'll put you on , um ... we'll change your blood pressure regimen . we'll put you on carvedilol , 25 milligrams twice a day . that helps with coronary disease as well as your pumping function of your heart . um , i wan na go ahead and order a cardiac catheterization on you and make sure that we do n't have any blockages in your heart arteries responsible for the chest pain .
[doctor] for the high blood pressure , we're gon na add the carvedilol and i want you to continue your lisinopril 10 milligrams a day and i wan na see , uh , how your blood pressure does on that regimen , okay ?
[patient] okay . sounds good .
[doctor] all right . so , the nurse will be in soon and i'll ... we'll schedule that cath for you , okay ?
[patient] you got it .
[doctor] hey , dragon , finalize the note .

Medical orders:
description: carvedilol 25 milligrams twice a day
order_type: medication
reason: low pumping function of your heart severe hypertension heart disease