Microsoft word - cohen-consult

IDENTIFICATION DATA: A 78-year-old male.

REASON FOR CONSULTATION: The patient is scheduled for total hip replacement, who has
hypertension, hypercholesterolemia, possible peripheral vascular disease, previous smoker. He
is a patient of Dr. John B. Luster. Surgery is scheduled for August 1, 2006.

HISTORY OF PRESENT ILLNESS: I saw the patient today, who is scheduled for total hip
replacement on the left. He has markedly limited excercise capacity to this, and has a history of
hypertension, hypercholesterolemia, and was a previous smoker. He has not had any chest pain
or angina, but does not do much exertion to be able to provoke this. He also has no history of
previous myocardial infarction. No typical exertional chest discomfort. There are no congestive
heart failure symptoms that are obvious. He has a history of borderline hypertension, for which
he was started on Plendil. He also has hypercholesterolemia and smoked until 1998. He has no
diabetes, no family history of premature coronary artery disease. He has no history of heart
murmurs, palpitations, dizziness, or syncope. No neurological symptoms. deep venous
thrombosis, intermittent claudication.

ALLERGIES: He has no known drug allergies.

CURRENT MEDICATIONS: Voltaren 50 mg a day; as well as Plendil 2.5 mg a day.
REVIEW OF SYSTEMS: Aside from that as mentioned above, is not contributory, except for
inguinal herniorrhaphy.

PHYSICAL EXAMINATION:
VITAL SIGNS: On examination his vital signs are pulse of 78, blood pressure 136/80,
respirations 14. Jugular venous pressure is elevated.
NECK: Carotids are 2+ bilaterally, without bruits.
CARDIOVASCULAR: S1, S2 with a short aortic ejection murmur. No signs of congestive heart
failure or pericardial rub.
CHEST: Clear to auscultation and percussion.
ABDOMEN: Soft and nontender. No hepatosplenomegaly or masses. Normal bowel sounds.
EXTREMITIES: Femoral pulses 1+ bilaterally, with posterior tibial and dorsalis pedis are not
palpable bilaterally.
NEUROLOGIC: No focal signs.
LABORATORY AND OTHER DATA: EKG shows sinus rhythm, within normal limits.
IMPRESSION
1. The patient is preoperative for hip surgery, with multiple risk factors of coronary artery disease,
including hypertension, hypercholesterolemia, previous smoking, and probable peripheral
vascular disease with absent distal pulses. Need to rule of significant coronary artery disease.
3. Hypercholesterolemia, not on treatment. 5. Absent distal pulses suggesting peripheral vascular disease/Buerger's disease from smoking.
PLAN
1. I recommend adenosine Cardiolite. Provided the adenosine Cardiolite test reveals no or a
very small area of reversible ischemia, we feel the patient is at mildly increased cardiac risk for
the planned surgery. If there indeed is a small area of reversible ischemia, will require beta
blockade prior to performing any surgery. If the adenosine Cardiolite scan shows a large area of
reversible myocardial ischemia, will then require further evaluation prior to a total hip
replacement.
2. Would like to see a copy of his past medical profile, and if necessary get his LDL to a goal of less than 100. 3. Further management dictated by the results of the above mentioned adenosine Cardiolite scan. I would continue his Plendil for the present . Thank you for this referral, Dr. Luster.

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