Hospitalist on Call Template

Subjective:
Pt ID:
The patient.

Original Reason for Admission:
The patient presents with progressive episodes of chest tightness that occur primarily with exertion, such as walking quickly or climbing stairs, and resolve with rest. The patient reports that these symptoms have been worsening over the past couple of years and has been avoiding strenuous activities to prevent symptom onset. The patient also experiences occasional palpitations, which are not consistently associated with chest discomfort. The patient has a history of moderate to severe obstructive sleep apnea managed with continuous positive airway pressure therapy, a benign thyroid nodule biopsied last year, and osteoporosis. The patient underwent two exercise stress tests with radionuclide imaging a few years ago, both of which were reported as normal.

Past Medical History:
The patient has a history of moderate to severe obstructive sleep apnea managed with continuous positive airway pressure therapy, osteoporosis, and a thyroid nodule that was biopsied last year and found to be benign.

Details of Current Episode:
The patient reports progressive episodes of chest tightness that occur primarily with exertion, such as walking quickly or climbing stairs, and resolve with rest. The symptoms have been worsening over the past couple of years, leading the patient to avoid strenuous activities to prevent symptom onset. The patient also experiences occasional palpitations, which are not consistently associated with chest discomfort. No palpitations or irregular heartbeats consistently causing chest discomfort.

Relevant Medications:
No relevant medications were discussed during the encounter.

Objective:
Vital Signs:
Blood pressure is 143/80 millimeters of mercury and heart rate is 60 beats per minute.

Physical Exam:
Cardiovascular examination reveals heart sounds normal without any murmurs. Respiratory examination shows lungs are clear.

Relevant Investigations:
Two previous exercise stress tests with radionuclide imaging were reported as normal.

Assessment and Plan:
The patient presents with progressive exertional chest tightness and occasional palpitations. Previous exercise stress tests with radionuclide imaging were normal. The plan includes performing an exercise stress test in the clinic to evaluate current exercise capacity, a 24-hour Holter monitor to assess for significant arrhythmias, and a cardiac computed tomography angiogram to visualize the coronary arteries. Metoprolol will be prescribed prior to the computed tomography angiogram to optimize image quality. Blood work will be ordered to screen for cardiac risk factors such as hyperlipidemia and diabetes mellitus. A follow-up appointment is scheduled in four to six weeks to review the results of the stress test and Holter monitor.