DATE OF CONSULTATION: June 12 REQUESTING PHYSICIAN: Trevor Sharpe, MD, Family Medicine CONSULTING PHYSICIAN: Kevin Palmer, MD, Cardiology HISTORY: This 52-year-old female was referred to our cardiology clinic by her family physician Dr. Trevor Sharpe. She had visited her physician last month with complaints of persistent fatigue, dizziness, light- headedness, fainting, and an inability to exercise without experiencing shortness + of breath. She claims that she is otherwise healthy; however, there is a history of cardiovascular ¥ diseases in her family. Her father had developed DVT during a long flight and subsequently suffered from pulmonary embolism " . Her mother had idiopathic intracranial hypertension and died from MI at a relatively young age. The patient has 3 siblings, 2 of them suffering from hypertension and hypercholesterolemia v . LABORATORY DATA: The laboratory results show normal CBC and Diff ¥ . Hemoglobin, Hct, WBC ' count, and platelet count are within normal range. The patient's PT and partial thromboplastin time are normal. ALLERGIES: She is not allergic to any medications. PHYSICAL EXAMINATION: Today the patient is alert and oriented but feels completely exhausted. She is also complaining of a mild chest pain. Her BP " is 180/110. Heart rate is in the high 50s with irregular rate and rhythm. NECK: is supple, without jugular VEenous + distention or bruits. LUNGS: are clear, without wheezing, rhonchi, or rales. IMPRESSION: | suspect the patient suffers from bradycardia ¥ and needs a pacemaker to regulate her heart rhythms. However, given the significant history of cardiovascular disorders in her family, | will order more tests before making a definite diagnosis. PLAN: | will admit the patient to a telemetry bed and monitor her for 48 hours. If her chest pain worsens, she will be moved to CCU and will be treated with intravenous ¥ nitroglycerin. An ECG " has also been ordered to confirm bradycardia. If the ECG results confirm my speculations, the patient will be scheduled for a pacemaker implant ¥ as soon as possible. Kevin Palmer, MD, Cardiology GEr 13/13 0
