CARDIOLOGY #4

HISTORY AND PHYSICAL EXAMINATION

CHIEF COMPLAINT: Shortness of breath.

HISTORY OF PRESENT ILLNESS: This 60-year-old female has been in good health all of her life. Two
months ago she awakened complaining of shortness of breath which had lasted all evening. She was
told that she had suffered a myocardial infarction. The records are currently not available but are being
sent for. The patient was observed for a period of 7 days and was then advised to have a temporary
pacemaker followed by a permanent ventricular pacemaker. Since that time the patient has been
discharged and has done very well. She has had no recurrence of the shortness of breath. There has
never been any chest pain described. The patient has been somewhat fatigued and has been limited in
what she can do, mainly because they were not advised what kind of activities were safe for her. She
has also noted pain in her axilla from the permanent pacemaker site. She has had no recurrence of
feeling shortness of breath similar to what brought her into the hospital originally.

PAST MEDICAL HISTORY: Illnesses: None.

Surgery: None.

MEDICATIONS: Isordil 5 mg q.i.d.

ALLERGIES: None known.

FAMILY HISTORY: There is no family history of early heart disease.

REVIEW OF SYSTEMS: Review of systems was essentially negative. The patient has had some cramping
in her legs and in her arms.
SOCIAL HISTORY: The patient does not drink or smoke.

PHYSICAL EXAMINATION

VITAL SIGNS: Blood pressure 170/94 in the right arm and 140/90 in the left arm. The weight is 154-1/2
pounds with shoes off.

HEENT: Head, eyes, ears, nose, and throat are unremarkable.

NECK: No jugular venous distention. The carotids are 2+ without bruits. The thyroid is not enlarged.

CHEST: The chest is clear to percussion and auscultation.

HEART: The PMI is not palpable. The heart is without gallop, rub, or murmur.

ABDOMEN: Abdomen is negative.

EXTREMITIES: Extremities are negative.

The chest wall reveals that the pacemaker site is over the left axilla, which is causing some local
discomfort in this region.

IMPRESSION

1. Status post myocardial infarction.

2. Permanent ventricular pacing.

RECOMMENDATION: The patient was advised to undergo a chest x-ray, a CBC, and return for a treadmill
stress test. At that time further recommendations as far as activity level will be made. The patient
could probably benefit from AV sequential or AV synchronous pacing. She could also benefit from a
relocation of her pacemaker site out of the axilla. These will be discussed as time goes by.