Chief Complaint: Tightness in the chest, shortness of breath, fast heart rate. HISTORY OF PRESENT ILLINESS: Mr. Barua is a 42 year old gentleman from Bangladesh who presents with chest tightness, shortness of breath, and tachycardia. Dr. J.K McClean of cardiology is evaluating his heart condition. The patient has had the recent onset of hemoptysis. He was treated for tuberculosis in Bangladesh 15 years ago. This has prompted the concern of weather his treatment of tuberculosis was adequate or if weather there is another cause of his hemoptysis. The duration of his tuberculosis treatment was apparently adequate, according to his wife. But no records are available. In addition, the patient had thrombosis of the axially artery treated last year at Hillcrest. He had an embolectomy and has been on Coumadin since. INR is significantly elevated at 16.
None the less, because of the cavitary lesions that are seen in the right and left upper lobes, the possibility of tuberculosis has been raised. Ancillary history was been given by the wife, Nupaul, with the patient translating for her from the Indie language. PAST HISTORY: Tuberculosis is the past. Embolectomy at Hillcrest last year. SOCIAL HISTORY: Married with two daughters. Patient has been in the USA for 10 years. The patient has no recent history of smoking he smoked in the past. But the amount is unclear. He is a restaurant manager for the Marriot hotel chain. FAMILY HISTORY: No known family history of diabetes, heart disease, or cancer. Mother died of a stroke and father was killed in a MVA in Bangladesh. REVIEW OF SYSTEMS: Negative other than as stated in HPI.
PHYSCIAL EXAMINATION: Vital signs are WNL. Apparently he has had no fever, chills or night sweats. Generalized malaise and the lack of energy has been the main concern. HEART: Regular rate a rhythm with S1 and S2. No S3 or S4 is heard at this time. LUNGS: Bilateral bronchi. No significant euphoric sounds were noted. ABDOMEN: Soft non tender. No hepatosplenomegagaly detected. RESTAL: Prostate smooth and firm, no stool present of Hemoccult test. DIAGNOSIS: Hemoptysis with history of tuberculosis.
PLAN: I have reviewed the chest x-rays available here and agree with the finding of bleb formation in the right and left upper lobes. Despite the patient has had a high INR, because of his history of hempotysis and tuberculosis I believe obtaining sputum for TB is very, very important. We should rule out any other endobronchial lesions are the cause of his bleeding. I have discussed this matter with the patient and his wife. I told them that there is a possibility of observing the condition via x-rays and repeated tested of sputum. They understand that this is an option However, they have decided because of the concern regarding of his repeating hemoptysis, they would consent to bronchoscopy. We will arrange for the patient to have a bronchoscopy done. The patient is off Coumadin. We will recheck the prothrombin time and INR tomorrow. Depending on those results we will proceed with bronchoscopy and further evaluation.
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