allergies: latex attending: chief complaint: doe, fatigue major surgical or invasive procedure: cabg x 5 (lima->lad, svg->rca, om, om, diag), asd closure history of present illness: 68 yo f with recent exertional sob referred for surgical revascularization after cath showed cad. past medical history: htn lipids tah tonsillectomy social history: retired opthamologist albanian - tob - etoh family history: nc physical exam: 59.8 inches 56.3 kg nad lungs ctab rrr no m/r/g abd benign no c/c/e pertinent results: 06:10am blood wbc-4.7 rbc-3.39*# hgb-10.8*# hct-30.4* mcv-90 mch-31.9 mchc-35.5* rdw-15.0 plt ct-237# 06:10am blood plt ct-237# 03:49am blood pt-13.6* ptt-27.5 inr(pt)-1.2* 06:10am blood glucose-99 urean-15 creat-0.4 na-141 k-3.6 cl-106 hco3-27 angap-12 echocardiography report , (complete) done at 11:29:04 am final referring physician information , division of cardiothoracic , status: inpatient dob: age (years): 68 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: intraoperative tee for cabg. icd-9 codes: 440.0, 424.1, 424.0 test information date/time: at 11:29 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2006aw02-: machine: 2 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 55% to 60% >= 55% aorta - valve level: 1.7 cm <= 3.6 cm aorta - ascending: 3.2 cm <= 3.4 cm mitral valve - e wave: 0.7 m/sec mitral valve - a wave: 0.7 m/sec mitral valve - e/a ratio: 1.00 mitral valve - e wave deceleration time: 220 ms 140-250 ms findings left atrium: no spontaneous echo contrast is seen in the laa. right atrium/interatrial septum: left-to-right shunt across the interatrial septum at rest. secundum asd. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness, cavity size, and systolic function (lvef>55%). normal regional lv systolic function. overall normal lvef (>55%). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. focal calcifications in aortic root. normal ascending aorta diameter. focal calcifications in ascending aorta. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: no mvp. no ms. mild to moderate (+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-bypass: 1. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 2. the aortic valve leaflets (3) appear mildly thickened with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. 3. mild to moderate (+) mitral regurgitation is seen. there is no mitral valve prolapse. 4. a secundum type atrial septal defect is present with a left-to-right shunt across the interatrial septum seen at rest. 5. right ventricular chamber size and free wall motion are normal. 6. no spontaneous echo contrast is seen in the left atrial appendage. post-bypass: 1. preserved -ventricular systolic function. 2. mitral regurgitation is slightly improved - now mild. 3. no evidence of aortic dissection. 4. chordal without lvot obstruction. 5. interatrial septum thickened - consistent with placement of pledgets. small "pin-hole" areas of left to right flow seen across septum - normal for this repair. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician final report indication: pleural effusion. pa and lateral chest radiograph compared to bedside ap chest radiograph dated . in the interval, there has been development of bilateral pleural effusions, left larger than the right. there are multiple linear densities in the left lung, representing probably atelectasis. cardiomediastinal silhouette is unchanged, given differences in technique. there are no infiltrates. osseous structures are unremarkable. impression: interval development of bilateral pleural effusions, left larger than the right. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 6:24 pm procedure date: ?????? caregroup is. all rights reserved. brief hospital course: ms. was taken to the operating room on where she underwent a cabg x 5 . she was transferred to the icu in critical but stable condition on propofol and neosynephrine. she was extubated later that day. her vasoactive drips were weaned by pod #2 and she was transferred to the floor. she did well postoperatively and was ready for discharge to home with vna on pod #5. medications on admission: asa, plavix, toprol, hctz, lipitor discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablets* refills:*0* 3. 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:*0* 4. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. toprol xl 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. disp:*30 tablet sustained release 24hr(s)* refills:*0* 6. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day) for 1 weeks. disp:*14 tablet(s)* refills:*0* 7. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po bid (2 times a day) for 1 weeks. disp:*28 capsule, sustained release(s)* refills:*0* 8. tramadol 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*60 tablet(s)* refills:*0* discharge disposition: home with service facility: gentiva health services discharge diagnosis: s/p cabg x5 cad htn lipids tah tonsillectomy discharge condition: good. discharge instructions: call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. shower, no baths, no lotions, creams or powders to incisions. no lifting more than 10 pounds or driving until follow up with surgeon followup instructions: dr. 2 weeks dr. 2 weeks dr. 4 weeks md Procedure: Single internal mammary-coronary artery bypass Extracorporeal circulation auxiliary to open heart surgery (Aorto)coronary bypass of four or more coronary arteries Transfusion of packed cells Repair of atrial septal defect with prosthesis, closed technique Diagnoses: Coronary atherosclerosis of native coronary artery Unspecified essential hypertension Hypopotassemia Other and unspecified angina pectoris Ostium secundum type atrial septal defect