HISTORY

Chief Complaint:
- SOB with diaphoresis and EKG en route to hospital showing 3-4 mm ST segment elevations in V4 through V6 with T-wave inversion in V4 through V6 and an inferior wall MI of indeterminate age.

History of Present Illness:
- This is a 71-year-old female with a long-standing history of heart problems since the age of 48 who was admitted to the coronary care unit to rule out acute lateral wall myocardial infarction.
- She began developing chest pain, shortness of breath, and diaphoresis about 5 days ago and was brought by ambulance, where an EKG showed ST elevation and T-wave inversion in V4 through V6 and an inferior wall MI of indeterminate age.
- She was started on nitrates and diltiazem with relief of her symptoms.

Past Medical History:
- Illnesses: Peptic ulcer disease, documented by endoscopy.
- She has a long-standing renal failure, although this has never been clearly documented in her prior hospital records, and her records from Japan are unavailable.
- She has an aortic aneurysm documented by abdominal CT in her most recent hospitalization, as well as previous cardiac catheterization at that time.
- There was no history of diabetes, cough, fever, paroxysmal nocturnal dyspnea, or hypercholesterolemia.

Medications:
- The medications she was taking at the nursing home include:
- Amphojel 30 mL p.o. q.i.d.
- Carafate 1 g q.i.d.
- FeSO4 325 mg t.i.d.
- Halcion 0.125 mg p.o. h.s. p.r.n.
- Pepcid 20 mg 2 q.h.s.

Social History:
- The patient was born in the United States but lived in Japan most of her life.

Family History:
- There is no family history of heart disease.

Review of Systems:
- Except as noted in HPI, noncontributory.

Physical Examination:
- Vital Signs:
- Blood pressure: 130/90
- Respiratory rate: 20
- Heart rate: 95
- Temperature: 98
- HEENT:
- Normocephalic, atraumatic
- PERRLA
- Fundi positive for AV nicking and narrowing
- No flame-shaped hemorrhages are seen
- Neck:
- Supple
- Jugular venous distention at 10 cm
- No carotid bruits
- Heart:
- Soft S1
- Normal S2
- S3 and S4 present
- No murmurs
- Lungs:
- Coarse, wet rales to halfway