allergies: patient recorded as having no known allergies to drugs attending: chief complaint: angina/doe/dilated ascending aorta major surgical or invasive procedure: s/p replacement of ascending and arch aorta/ cabg x1 (svg to pda)with 34 mm gelweave graft/ resusp. aortic valve on history of present illness: 57 yo female recently diagnosed with ascending aortic aneursym,, aortic insufficiency and cad. has had increasing episodes of chest tightness this winter. had a + ett and was sent for cath. cxr showed enlarged aorta. ct scan done revealed asc. aorta 5.2cm, arch 5.3 cm, desc. 4.6 cm, 3.5 cm prox to renal arts., 3.2 cm at renals, 3.1 cm below renals, and normal size at bifurcation. referred to dr. for surgical repair/cabg. past medical history: htn elev. chol. tobacco abuse aortic aneurysm old right clavicular fractures pna mild right le varicosities social history: works as a public safety dispatcher smokes 1 ppd for 40 years very seldom etoh lives alone, separated, 2 kids family history: premature cad father and brother physical exam: hr 88 right 152/86 left 156/80 5' 7" 160 # skin tag left upper thigh upper denture, lower partial plate perrla, eomi, anicteric, no jvd or carotid bruits appreciated ctab rrr s1 s2 diastolic murmur soft, nt, nd, + bs , no hsm or cva tenderness warm, well-perfused, no edema nonfocal neuro exam, mae strengths 2+ bilat. fem / radials; np dp pulses, 1+ bilat. pt pertinent results: 05:30am blood wbc-10.1 rbc-3.73* hgb-12.0 hct-34.2* mcv-92 mch-32.1* mchc-35.0 rdw-13.9 plt ct-273 10:54am blood neuts-71.3* bands-0 lymphs-17.7* monos-6.3 eos-1.8 baso-2.9* 05:30am blood plt ct-273 05:30am blood urean-22* creat-1.0 k-4.8 brief hospital course: admitted on and underwent diagnostic tee in the or. surgery postponed due to need for further evaluation with the vascular . team. repeat scan performed, and underwent cabg x1/resusp. av/ replacement of ascending and arch aorta on by dr. . transferred to the csru in stable condition on epinephrine, nitroglycerin, and propofol drips. weaned from vent on pod #1 on neo and propofol drips. gentle diuresis started on pod #2. she was transferred to the floor to start increasing activity level on pod #3 and beta blockade was started. she has some sternal drainage and was started on vancomycin. she required increased pulm. toilet for a productive cough. on she fell while getting up without assistance and hit her head. she denied any dizziness or loc. she was examined by the ct fellow and was neurologically intact, but had a 1.5 cm head laceration. this was closed with staples. chest and head ct were negative. vanco changed to levaquin for sternal drainage on pod #5. she continued to make good progress and sternal drainage decreased on pod #7. cleared for discharge to home with vna services on pod #8. patient will return here for wound check and cta scan of chest/abd/pelvis with mms reconstruction on . medications on admission: atenolol 25 mg zetia 10 mg daily asa 325 mg daily discharge medications: 1. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po twice a day for 5 days. disp:*20 capsule, sustained release(s)* refills:*1* 2. lasix 20 mg tablet sig: one (1) tablet po twice a day for 5 days. disp:*10 tablet(s)* refills:*1* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) for 1 months. disp:*60 tablet(s)* refills:*0* 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 7. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. albuterol sulfate 0.083 % solution sig: one (1) neb ih inhalation q6h (every 6 hours) as needed. disp:*5 neb ih* refills:*0* 9. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. disp:*100 ml(s)* refills:*0* 10. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po twice a day. disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: nursing services discharge diagnosis: s/p replacement of ascending and arch aorta/ cabg x1 (svg to pda)/ resusp. aortic valve htn tobacco abuse aaa elev. chol discharge condition: stable discharge instructions: no lotions, creams or powders on any incision may shower and pat dry no driving for one month no lifting greater than 10 pounds for 10 weeks call for fever, redness or drainage followup instructions: wound check on 2 thursday ct scan of chest/abd/pelvis with mms reconstruction protocol in 2 weeks. this has been scheduled for thursday at 1:00 pm . see dr. in weeks see dr. in weeks follow-up with dr. in 4 weeks Procedure: Venous catheterization, not elsewhere classified Extracorporeal circulation auxiliary to open heart surgery Diagnostic ultrasound of heart (Aorto)coronary bypass of one coronary artery Resection of vessel with replacement, thoracic vessels Closure of skin and subcutaneous tissue of other sites Transfusion of packed cells Other repair of vessel Transfusion of platelets Transfusion of other substance Diagnoses: Coronary atherosclerosis of native coronary artery Tobacco use disorder Unspecified essential hypertension Thoracic aneurysm without mention of rupture Open wound of scalp, without mention of complication Other and unspecified hyperlipidemia Other and unspecified angina pectoris Fall from other slipping, tripping, or stumbling