Coronary Artery Arthritis

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FINAL DIAGNOSES
1. Recent myocardial infarction (inferior wall).
2. Recent gastrointestinal bleed.
3. Hypertension.
4. Diabetes mellitus.
5. Hypothyroidism.
6. Arthritis.
7. Dementia.
8. Anemia.

PROCEDURES
1. Cardiac catheterization by Dr. [Name], 11/5.
2. Coronary artery bypass grafting x3 (LIMA to the LAD, saphenous vein graft to the ramus with endarterectomy, saphenous vein graft to the right coronary artery), by Dr. [Name], on 11/8.

CONSULTATIONS
Dr.s [Name]. Please send them copies, as well as 1 to Dr. [Name]'s office.

DISCHARGE MEDICATIONS
Percocet p.r.n. pain, Restoril 15 mg p.r.n. sleep, Colace 100 mg daily, Ascriptin 1 daily, Plavix 75 mg daily, Zantac 150 mg b.i.d., Lopressor 12.5 mg b.i.d., Ativan 0.5 mg t.i.d. p.r.n. …show more content…

CT of the brain at that time showed volume loss. Two days later, he was in the Emergency Department at [Place] for right upper quadrant pain and chest pain. At that time, his EKG was significant for an inferior wall myocardial infarction. He was treated with Tridil and heparin. He had positive CPKs and troponin. Adenosine stress test demonstrated reversible apical ischemia with injection fraction of 58%. However, an echo demonstrated infero apical and lateral infarction. Ejection fraction there was estimated at 25%. He was transferred to [Place] for …show more content…

He was intermittently confused, but did quite well. Physical therapy and occupational therapy were instituted.

He was noted on his 2nd postoperative day to have a hematocrit of 24, and was transfused with 2 units.

Gradually and slowly, his ambulation improved. It was noted on his 5th postoperative day that he had some drainage from the inferior aspect of his sputum, and it was felt that IV vancomycin should be continued. Evaluation was made for rehab, and he was accepted to [Place]. Once it was felt that his sternal wound drainage had decreased, he was changed from IV vanco to p.o. Cipro. His blood sugars will continue to be followed at rehab.

On 11/17, he was transferred to [Place].

Final labs showed a glucose of 161. BUN and creatinine had improved to 22 and 1.2, potassium 3.9. White count 6.85, hemoglobin/hematocrit 11 and 33.7, post transfusion. Platelet count had improved to 257,000. He did have a differential on the 13th, which showed _____(2 bands). Wound culture was originally negative at 48 hours, but then did grow some staph, which was susceptible to the IV

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