allergies: lisinopril / ampicillin attending: chief complaint: cardiac arrest major surgical or invasive procedure: cardiac catheterization history of present illness: ms. is a 52 y/o schoolteacher w/ htn admitted to ccu s/p cardiac arrest while walking into school this am. per report, cpr was initiated by her co-workers. when ems arrived she was found pulseless and apneic and one shock was delivered. she was then found to be breathing at a rr of 10 with a rapid pulse, but was still unresponsive. she was bolused 100 mg of lidocaine io. cardiac monitor per ems report showed sinus tach at rate of 140 with a bp of 150/100. patient then became responsive. lidocaine infusion at 1 mg/min was started. she was transferred to ed for further management. in the ed, intial vs: temp: 98.6 hr: 115 bp:147/92. the lidocaine gtt was stopped. she was given 50 mg of fentanyl and 4 mg of zofran for chest pain and nausea. the patient states she felt herself "blackout" immediately before the arrest and remembered nothing else. she denies pre-syncope, syncope, palpitations, chest pain or sob. she has had atypical exertional chest pain since of this year, having severe neck pain radiating to shoulders in the morning during light exertion, lasting less than 5 minutes. she had a stress test which was equivical and subsequently had a cardiac cath at which was normal per patient. she admits to the sensation this morning, prior to her arrest. . in the ed she was seen by the ep service who placed icd for secondary prevention. she was then transferred to ccu for further monitoring. past medical history: . past medical history: hypertension . past surgical history: 3 c-sections appendectomy social history: 4th grade teacher, remote smoking history. quit 25 years ago, smoking ppd for 5-10 years. drinks glasses of wine per week. denies drug use. family history: mother: died of heart failure at age of 52 secondary to a "virus". no history of arrythmias, syncope, or sudden death in the family. physical exam: admission exam: gen: pleasant, calm heent: no conjunctival pallor. no icterus. mmm. op clear. flushed face. neck: supple, no lad. jvp low. cv: pmi in 5th intercostal space, mid clavicular line. regular and tachycardic. normal s1,s2. no murmurs, rubs, clicks, or lungs: ctab. no wheezes, rales, or rhonchi. abd: nabs. soft, nt, nd. no hsm. ext: wwp, no cce. full distal pulses bilaterally. skin: no rashes/lesions, ecchymoses. neuro: a&ox3. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. normal coordination. gait assessment deferred pertinent results: 08:50am ctropnt-<0.01 11:15pm ck-mb-5 11:15pm ck(cpk)-221* echo: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: 52 yo female with h/o htn, who is admitted for cardiac arrest. #. cardiac arrest: pt received one shock in the field suggestive of vf or vt rhythm. cardiac cath showed 80% lad occlusion which was the culprit lesion, s/ . echo revealed preserved cardiac function. ep followed patient, decision was made not to place icd since the lad occlusion was the source of the cardiac arrest. . #. cad: pt with 80% occlusions of lad s/ . this lad lesion was 20% in at cardiac cath. pt was started on medical management for cad. metoprolol, atorvastatin, asa 325mg, plavix, was started in lieu of ace-i secondary to allergy. her lipid panel revealed tag 154, hdl 50, ldl 104. started on atorvastatin 80mg daily her hba1c was pending at time of discharge. . # htn: held home dilt. started metoprolol 25mg and will go home on metoprolol. . #lfts: pts lfts were found to be elevated (400s alt, 200s ast). they trended down mildly. differential included components of shock liver in setting of cardiac arrest versus underlying chronic transaminits (possible nash). patient should follow this up outpatient. . #chest pain: pt had chest pain from chest compressions and likely underlying rib fx. cxr was neg for obvious fractures. pt was treated with narcotics and tramadol for pain which controlled symtoms. pt will go home with vna services medications on admission: diltiazem er 240 mg daily (did not take this am) discharge medications: 1. aspirin 325 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:*3* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*3* 3. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*3* 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*3* 6. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain for 6 days. disp:*36 tablet(s)* refills:*0* 7. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours). 8. senna concentrate 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation for 7 days. disp:*14 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: cardiac arrest left anterior descending artery occlusion status post drug eluting stent coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to take care of you during this hospitalization. you were admitted to the hospital for cardiac arrest. essentially, your heart was beating in a bad rhythm and not pumping blood forward. you were found to have a clogged artery going to your heart which explained why you went into cardiac arrest. the artery was opened with a stent. you were started on several new medications to protect your heart. it is very important to take these medications every day. you also had chest pain which was attributed to rib fractures from chest compressions during cpr. this is treated with rest and pain medications. please follow up with your primary care doctor at the appointment below. it is also important to follow up with a cardiologist. please refrain from strenuous activity for one week. follow up with your cardiologist. the following changes were made to your medications: stop diltiazem start: atorvastatin 80mg daily clopidogrel 75 mg daily metoprolol succinate 50mg daily valsartan 80mg daily ultram 50mg every 6 hours as needed for pain ibuprofen 400mg every 8 hours as needed for pain followup instructions: primary care doctor appointment- monday, at 8:45 am name: , a location: primary care address: ste 441white, newon, phone: cardiologist appointment: dr. , at 2:40pm. , sharpio 7 , phone: Procedure: Coronary arteriography using two catheters Arteriography of femoral and other lower extremity arteries Insertion of drug-eluting coronary artery stent(s) Cranial or peripheral nerve graft Insertion of one vascular stent Excision of lingual thyroid Percutaneous transluminal coronary angioplasty [PTCA] Procedure on single vessel Diagnoses: Anemia, unspecified Coronary atherosclerosis of native coronary artery Unspecified essential hypertension Acute and subacute necrosis of liver Personal history of tobacco use Cardiac arrest Ventricular fibrillation Other chest pain Other chronic nonalcoholic liver disease