Cotocu Daiana-Roxana, grupa 9, seria B

Name: John Smith

Sex: Male
Age: 47 years
Height: 6’4
Weight: 175 pounds
Symptoms:
- Pressure on the chest
- Pain radiating in the left hand
- Loss of appetite
- Weight loss
- Smoker
- Stress
Main disease: minor heart attack
Accompanying diseases: bronchial carcinoma
Complication of the disease: high blood pressure

Anamnesis morbi:
Complaints: chest pain, loss of appetite
The patient isn’t responding to coughing pills.
The patient is functioning normal throughout the day: has a full time job, spends time with family
and friends.
The patient has undergone a vasectomy 6 moths ago with no further damages being made.
The patient was brought in by an ambulance.

Anamnesis vitae:
1. Social anamnesis
The patient is working as a full time architect.
The patient has no exposure to chemicals, dusts or molds.
The patient has not traveled abroad in the last year.
2. Familial anamnesis
The patient’s father died from cancer: primary source were the lungs.
The patient’s mother has type II diabetes and tachycardia.
3. Anamnesis of previous diseases
The patient has a ventricular septal defect for which he undergone surgery at 5 years old.
4. Anamnesis of pernicious habits
The patient has been smoking 1 pack of cigarettes/day for the last 20 years => 365 packs/
year => 7300 packs overall.

Objective Examination:
The patient has been ordered to do a full blood work.
The patient has undergone a chest X-ray that shows masses in the left lung.
The patient has been ordered to take a sputum cytology, a CT scan and a PET scan.
Clinical diagnosis: minor heart attack and regional bronchial carcinoma.

Treatment: beta-blockers and ACE-inhibitors, chemotherapy followed by a lobectomy.

15mg Coreg/day, 1250mg Vasotec/day

 Cotocu Daiana-Roxana, grupa 9, seria B

- Good afternoon, Mr. Smith! What can I do for you today?
- Good afternoon, doctor! I am here because I’ve been coughing a lot lately and my
throat is really sore. I have days when I can’t swallow anything at all so I lost a
couple of pounds due to this. I also had a throbbing pain in my left side two days
ago, which is now radiating towards my left hand.
- I see. Do you take any medication at the moment?
- No, sir. I have been healthy for the most part of my life and this really scares me. I
don’t feel like myself anymore. I tried a couple of coughing pills, but they didn’t
work.
- Are you a smoker?
- Yes, doctor. I’ve been smoking a pack a day for the last twenty years.
- Have you been travelling recently?
- No, not in the past year.
- What do you do for a job, sir? Are you prone to inhale chemical fumes or
- I am an architect.
- What about preexisting conditions?
- Well, sir, I had a vasectomy six months ago, but everything went smooth. I had
surgery at 5 for ventricular septal defect but I did my best to go to every
appointment and nothing bad showed up ever.
- Did you go to your cardiology appointment prior to today?
- Yes, doctor. My cardiologist said the problem has nothing to do with my condition.
I request some blood work just to be sure but I am still waiting for the results.
- Can you tell me anything relevant about your parents?
- My mother has diabetes and tachycardia and my father died from cancer primarily
located in the lungs.
- I think I know what the problem is, but before prescribing a treatment, I want you
to take a chest X-ray and a sputum cytology and I’ll review them afterwards.
- Am I going to be okay, doc?
- I sure hope so, but your chances increase if you follow my advice precisely.
- I will, sir. I promise.
- Good. Now, Grace, can you take mr Smith to radiology, please?
- Yes, doctor. Come with me, mr. Smith, please!
- Thank you a lot, doctor! Have a good day!
- See you soon for those results!

 Cotocu Daiana-Roxana, grupa 9, seria B

Dr.: Good evening, Mr. Smith. I am the cardiologist on duty tonight and as the
paramedics informed me, you are suffering from an acute shortness of breath. Can
you understand what’s happening?
JS: I cannot quite feel my arm at the moment. What is happening to me?
Dr.: I want you to try to stay calm. What arm are you referring to?
JS: My left one.
Dr.: Is the pain radiating from your chest?
JS: Yes.
Dr.: Can you feel your fingers?
JE: No. They’re numb.
Dr.: Okay, so numbness in your fingers combined with chest pains and shortness in
your breath point to a heart attack. It is very important that you try to stay calm! I am
now going to attach some electrodes and perform an ECG to see what’s happening
exactly. It is painless and it will give me the results right after we finish speaking. Do
I have your approval?
JS: I’m trying to stay calm. Yes, you do.
Dr.: Do you take any medications, mr Smith?
JS: Not for my heart, no. I am a lung cancer patient so I am on chemo and I took
some coughing pills because my throat was really sore lately, causing me to be unable
to eat for the last couple of days.
Dr.: Do you smoke?
JS: One pack per day for the last twenty years, miss.
Dr.: Do you know of any family members to have had heart conditions?
JS: Yes, my mother has tachycardia and diabetes, while my father died of lung cancer.
Dr.: Have you had any heart interventions? I see a scar on your chest.
JS: I was in surgery when I was 5 due to a ventricular septal defect.
Dr.: Did you go to your regular appointments?
JS: I never missed one, doctor. I haven’t taken a vacation in years for fear of
something happening abroad. Nothing showed up, though.
Dr.: I see. The ECG showed you had a minor heart attack. I want you to take this
cocktail of medicines. They’re beta-blockers -carvedilol - Coreg, to be exact with an
ACE-inhibitor known as enalapril, the Vasotec. The first ones are to lower your blood
pressure, while the second ones will block your vessels from constricting and causing
further damage to your heart. I am going to prescribe some anticoagulants as well.
Are you allergic to something?
JS: I cannot take heparin. I had a vasectomy six months ago and I discovered I am
allergic to it, but nothing else I know of.
Dr.: Good. Now that we had that cleared, I am requesting your full blood work, a CT
and a PET scan. Is that okay?
JS: Yes, doctor.
Dr.:I’ll ask my colleague on the oncology department to perform a sputum cytology
and an X-ray to see how your lungs are holding up. Is that okay with you?
JS: Yes, doctor.
Dr.: Now you must rest. The meds should’ve done their job by now and I expect a
full recovery from this event, but I want you to try to improve your lifestyle a little by

 Cotocu Daiana-Roxana, grupa 9, seria B

adding sports and following a low-sodium diet. The nurse will give you a list
consisting of all the food that is strictly forbidden and you will have your drug
prescription by morning. We are going to keep you overnight just to make sure
everything went smoothy and in the morning you can go home, but I want to make
sure that you understand this might happen again if you’re not following my advice
strictly.
JS: I understand, doctor. Thank you!
Dr.: I did my job, now it’s time you do yours. Take care and I’ll see you in the
morning!