Discharge summary

Most Responsible Diagnosis: Progressive exertional chest tightness, likely angina.

Pre-Admit Diagnoses: 
- Sleep apnea (moderate to severe, managed with CPAP machine)
- Thyroid nodule (benign, previously biopsied)
- Osteoporosis

Post-Admit Diagnoses: No information available.

Secondary Diagnoses: Occasional palpitations.

Code Status: No information available.

Other Interventions: 
- Exercise stress test to evaluate current exercise capacity.
- 24-hour Holter monitor to assess for arrhythmias.
- Cardiac CT angiogram for detailed imaging of coronary arteries.
- Blood work to screen for cardiac risk factors (cholesterol and diabetes).

Allergies: No information available.

Medications on Discharge: 
- Metoprolol prescribed to improve imaging quality for the cardiac CT angiogram.

Post-Discharge Follow-Up: 
- Follow-up appointment in 4-6 weeks to review the results of the stress test and Holter monitor.
- Discussion of cardiac CT angiogram findings if available.
- No additional follow-up details provided.

Discharge Disposition: No information available.

Treatment/Course in Hospital: 
The patient presented with progressive exertional chest tightness and occasional palpitations. Previous stress tests were normal, but symptoms have worsened over the last few years. A thorough evaluation plan was established, including an exercise stress test, a 24-hour Holter monitor, and a cardiac CT angiogram. Blood work was ordered to assess cardiac risk factors. The patient was prescribed metoprolol for preparation for the CT angiogram and instructed to follow up in 4-6 weeks.