{"text":"NHS Confidential: Personal data about a patient \nNorwood Henry CHI: 0101506015 OPCL 27\/12\/2023 v1 \nChanges to medication : Please switch Atorvastatin to Rosuvastatin 5mg once daily, increase \nBisoprolol to 10mg once daily and increase Ramipril to Smg twice daily. \nOutstanding investigations : Nil. \nFollow up : Routine return. \nMany thanks for referring this 73 year old gentleman whom | reviewed at the Cardiology Clinic today. \nSubsequent to referral, he was admitted under my colleagues in September with non cardiac chest \npain. \nToday he describes limiting symptoms. He tells me he is exhausted walking across the room and \nshort of breath on very minimal exertion. He describes a chest tightness which is mostly there all \nthe time and affects his upper chest. It appears to get a little worse with \"moving\" but is different in \ncharacter from his ischaemic pain which was more of a retrosternal burning sensation. He has not \nused sublingual GTN for some time but when he did try it for this continuous chest heaviness it did \nnot help. \nHe has of course known ischaemic heart disease having suffered an inferior STEMI in May of this \nyear and requiring primary PCI to right coronary artery. It was noted he had moderate but non \nobstructive coronary disease in his LAD as well. Echocardiography showed preserved biventricular \nfunction with an ejection fraction 65% of the left ventricle. \nWe explored drug compliance. He tells me that he does not take his statin regularly and over \nthe last month has maybe taken 8-10 doses. He feels less \"panicked\"\u201d when he is not taking his \nstatin but tells me that he takes his other tablets regularly. Unfortunately he continues to smoke, \ngetting through 2-3 cigarettes most days. He has known COPD with moderate airflow obstruction \non previous testing. He measures his oxygen saturations at home and they tend to sit hetween \n91-95%. He has noticed on monitoring his pulse oximetry that his heart rate has increased. \nOn examination he was comfortable at rest. His heart rate was 108 beats per minute in regular sinus \nrhythm and his blood pressure elevated at 177\/114. His height is 167 5cm with a weight of 58kg \ngiving a BMI of 20.6. He was euvolemic with no evidence of cardiac decompensation clinically. \nHe has reduced chest expansion and reduced air entry bilaterally with bronchovesicular breath \nsounds consistent with COPD. \n| do not think that his continuous chest heaviness is ischaemic as it is very different in character from \nischaemic events and almost continucus. | suspect his breathlessness is predominantly due to \nCOPD given his good cardiac function and lack of clinical heart failure. \nPrinted on 03\/01\/2024 15:39 by Geraldine Cullen Page 2 of 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