825330116
HLGMC
6051380
10615/2646
8/15/1993 12:00:00 AM
ACUTE MYOCARDIAL INFARCTION .
Unsigned
DIS
Report Status :
Unsigned
ADMISSION DATE :
8-15-93
DISCHARGE DATE :
08-22-93
PRINCIPAL DIAGNOSIS :
Acute myocardial infarction .
ASSOCIATED DIAGNOSIS :
1. Coronary artery disease ,
2. unstable angina ( postmyocardial infarction angina ) ,
3. Parkinson 's disease .
SPECIAL PROCEDURES AND OPERATIONS :
1. Percutaneous transluminal coronary angioplasty and coronary atherectomy of the left anterior descending , 8-17-93 ,
2. relook coronary angiogram , 08-18-93 .
DOCTORS DISCHARGE ORDERS AND MEDICATIONS ON DISCHARGE :
Ecotrin 1 tablet PO qd , Captopril 6.25 mg PO tid , K-Dur 20 mEq. PO qd , Lasix 20 mg PO qd , Isordil 10 mg PO tid , Sinemet 1/2 tablet PO bid , Symmetrel 100 mg PO bid , Parloder 2.5mg PO qd .
HISTORY OF PRESENT ILLNESS :
The patient is a 58 year old female with a history of Parkinson 's disease for more than twenty years who presented to the Gemenadentoolpai Medical Center with a revolving anterolateral wall myocardial infarction on 08-01-93 .
She has been under the care of Dr. Aalv Manual and was referred here for further therapy .
She had no prior significant cardiac history and presented to her local medical doctor 's office with an episode of severe retrosternal chest pain .
Her electrocardiogram showed a new right bundle branch block and left anterior hemiblock .
The patient was transferred to the Gemenadentoolpai Medical Center and was admitted .
Her hospital course was remarkable for ruling in for a myocardial infarction with a peak CPK of 9,379 units with a 5.9% MB fraction .
In addition , on telemetry she developed complete heart block and hypotension requiring temporary pacing wire and then a permanent pacemaker implantation on 08-03-93 .
She developed congestive heart failure and required pressor support .
She underwent cardiac catheterization on 8-15-93 and was found to have a left ventricular end diastolic pressure of 28 millimeters of mercury .
She had a dominant right coronary artery with minor disease .
The main left coronary artery had a 20% stenosis .
The left anterior descending had a severe 80% proximal stenosis with a filling defect consistent with intraluminal thrombus .
The circumflex artery had a minor 40% stenosis .
Cine left ventriculogram revealed a dilated left ventricle with an area of anterolateral , apical , and septal akinesis .
The left ventricular ejection fraction was estimated to 38% .
The patient was transferred to the Heaonboburg Linpack Grant Medical Center for consideration of coronary angioplasty .
CARDIAC RISK FACTORS :
Her risk factors for coronary artery disease included a positive family history and an elevated cholesterol level .
PAST MEDICAL HISTORY :
Her past medical history is remarkable for a history of Parkinson 's disease .
PHYSICAL EXAMINATION :
Her physical examination at the time of admission revealed a pleasant lady in no acute distress .
The blood pressure was 120/70 millimeters of mercury .
Her pulse was regular at 80 beats per minute .
The jugular venous pressure was elevated at 6 cm above the sternal angle .
The carotids were normal .
The chest was clear .
The cardiac examination revealed anapical impulse in the fifth left intercostal space , left to mid clavicular line .
The first sound was normal .
The second sound was normally split .
She had no murmurs and no gallops .
The examination the abdomen was benign .
The examination of the extremities showed no edema .
She had good pulses bilaterally .
LABORATORY DATA :
Her electrocardiogram revealed normal sinus rhythm , left atrial enlargement , left axis deviation , poor R-wave progression in V1 through V4 , consistent with marked clockwise rotation , cannot rule out an old anteroseptal wall myocardial infarction .
There were prominent Q-waves in AVL , consistent with lateral myocardial infarction .
There were non-specific ST-T wave abnormalities .
HOSPITAL COURSE :
The patient was admitted to the Medical Service .
The patient was seen in consultation by the Neurology Department because of the history of Parkinson 's disease .
The patient was maintained on intravenous heparin .
On 8-17-93 , she was taken to the cardiac catheterization laboratory where she underwent percutaneous transluminal coronary angioplasty of the proximal left anterior descending .
Following balloon angioplasty , there was a local dissection with evidence of intraluminal thrombus , with a greater than 10% loss in the initial gain following coronary angioplasty .
Therefore , directional coronary atherectomy was performed with an excellent angiographic outcome , and a less than 10% residual narrowing .
The patient tolerated the procedure well .
She was maintained on intravenous heparin and was brought back to the cardiac catheterization laboratory on 08-18-93 for a relook coronary angiography .
Coronary angiography demonstrated ongoing benefit of the initial coronary atherectomy .
Specifically , there was no decrease in the initial gain that she achieved after directional atherectomy .
The patient remained stable during the rest of the hospitalization .
She was transferred in stable condition to the Pasi for further rehabilitation therapy .
RENLAN FYFEZEIS , M.D.
Dr. Aalv Lorjes Salv Manual Pasi
TR :
jb / bmot
DD :
9-17-93
TD :
09/19/93
CC :