Name of the Patient -Tsiure Khizinishvili

Age – 77
Sex – Female
Date – 18/01/2021

The History

Complaint and present illness – Ms Tsiure was admitted to the emergency

department on 14/01/2021 as she had fainted and had complained of shortness of
breath, tachypnoea, palpitations and fatigue.
Vitals- RR – 33/min, sPO2 – 82%, Pulse -130bpm , BP – 200/110mmHg. The patient
appeared to be cyanotic.

Present illness continued:

Before this event the patient had a history of hypertension which she was managing
with Captopril. In the last 3 days or so she says that her blood pressure was high
with ranges from 160,170 and 180.(systolic BP). She was admitted to the
Emergency ward as she had fainted and when her eyes opened up she realized she
was in the hospital. She was given Oxygen Supplementation. Patient was alert and
oriented to time, place and person. Lower extremity edema was present.
Covid test result was Negative

Cardiology consultation was needed. Upon Consultation a chest CT was performed.

The patient was suspected for Pulmonary Embolus. (D – Dimer test was not
performed, I would have thought of performing that before moving on with CT)

Medications that were started –

Past medical History – The patient had a history of Heart failure and Atrial
fibrillation. The patient also has history of stent placements. In total she had 3 of
them. The recent one being in the last year. 30 years ago she had Thyroidectomy in
which she used to take hormones but now she doesn’t. 9 years ago she had
cholecystectomy due to presence of gall stones. Last year she had treatment for her
varicose veins. She also had an orthopaedic reconstructive surgery of the right ankle
after a fall. Appendectomy was also performed when she was young. She used to
have mild asthma attacks.
No Known allergies.
Medications – Captopril and heparin ( she wasn’t adherent with her medications.)
Family History – Mother and Father passed away of natural causes. 4 out of her 6
siblings passed away due to stroke.
Social History – Not available
ROS:
General: No weight or appetite loss
HEENT: No vision or hearing loss
CV: No orthopnoea , palpitations were present
Pulmonary: shortness of breath
GI: no diarrhea or vomiting
GU: no UTI, dysuria or oliguria
Skin: pallor, no rashes
Neurologic: no headache

DDX –
1) Pulmonary Embolus
2) Myocardial Infarction
3) Stroke

Labs –

14/01/2021 19/01/2021
Lactic Acid 3.54 normal
HCO3 20.4 20.3
pCO2 36 35.7
CRP 8 normal
Neutrophil count on 14 was increased – 76.4
D Dimer test – 2041.57

EKG – Sinus rhythm , equal rhythm intervals, normal rate, no abnormalities .

CT scan – A thrombus on the left lower region of the lung
Echocardiograph – Shows that there is diastolic dysfunction, there is left atrial
enlargement, The EF has slightly reduced to 46%.

Assessment –
Ms Tsuire is a 77 year old female who comes in with complains of shortness of
breath, tachypnoea, Palpitations, fatigue and loss of consciousness.

Plan/Problem list –
1. Shortness of breath
 Differential – The patient had a history of Atrial fibrillation and has not
managed with any medications. This could be one of the reasons why she
unilateral extremity swelling as well as the shortness of breath. Although the
pressure is Aortic dissection can be ruled out because of lack of pain.
Congestive Heart failure can be ruled out as well because there is no trace of
bilateral extremity edema.

Assessment – Currently the shortness of breath doesn’t exist after treatment

has been initiated.

Diagnostic plans – Coagulation studies, D Dimer and CT scan to rule out any
possibility of thrombus formation.

Treatment plan – Supplemental Oxygen , Heparin , Warfarin

2. High Blood pressure

Patient denies use of any medications, other than captopril for her acute rising
blood pressures.

Assessment – High BP

Diagnostic/ Treatment plan – Calcium channel blocker, Beta blocker