So next patient is tracy gibbons 803749 49 year old lady investigations urea 10.2 creatinine 82 sodium and potassium normal lfts normal troponins 14 and 8 d dimer naught 0.2 white cells 11.7 with lymphocytes 5.8 recent mri cardiac myocardial viability study demonstrating signal in the anterior and septal regions throughout suggestive of myocardial edema no evidence of lv infarction normal lv volumes left bundle branch block invasive cardiac catheterization may 2025 ejection fraction 33% unobstructed coronaries ct pulmonary angiogram may 2025 05/23/2025 to be exact small volume pulmonary emboli bilaterally in the segmental arteries e g medial and posterior segmental left lower lobe arteries yeah yeah of course it's the 1 I think jess spoke to you about oh yes for sure he's with the pe guy yes yeah we he's got a pe I don't think it'll change anything will it the bloods and they've just found apparently they just found out that he's okay fine so his prostate is felt abnormal apparently okay we can have a look can't we but but I haven't seen the result about the scan pe positive non stifle changes enlarged prostate so I don't know what they've said at clinic but apparently his prostate felt bad bone metastases he hasn't got any metastases but they think his prostate looks feels malignant and it looks enlarged on the needs an mri of his pelvis probably a biopsy to really tell yeah but obviously that's the urologist basically he's just here for blood thinner medications exactly for anticoagulation yeah yeah I don't know why right could they not have done that incident absolutely no idea yeah but that's what we do he literally just been to the clinic is that why we've got all his notes and stuff so I'm guessing so invisible denature in there this was fourteenth of the saddle disease yeah so you didn't have prescribers aren't you yeah they said something didn't they hematuria clinic large smooth prostate no sensitive features okay medical aesthetic fine stay on penastatin twok 3 months so they don't think it feels malignant that's good isn't it mhmm fine so we'll just treat his pe that's literally all in check for and they've left their clinic list in there just the notes com comment comment that's just his note his list so I can pop him back in the waiting area yeah pop him back in the waiting area thanks so much cheers take care all of that stuff about the ecg is a different patient observations restricted to 16 suctions oxygen saturation 96% on air blood pressure a 125 every 7 pulse a 100 per minute temperature 36.8 ecg stable 1 mm elevation borderline left bundle branch block no dynamic changes echocardiogram may 26 severely dilated lv with eccentric lvh severely impaired systolic function ejection fraction 33% mild ar dilated la borderline ra dilatation normal rv no mobile echogenic material tracy gibbons please tracy gibbons tracy gibbons medical history hepatitis c without cirrhosis iv drug use yeah pulmonary embolism 2025 recent admission in from may late may to early june 20 25 treated for bilateral small volume pulmonary emboli infectious aspiration of cpd and possible myocarditis past medical history previous dvt okay do you plan for follow-up mri in 3 months sorry just need to give me next how are you yeah I'm alright nothing good yeah tell me all about it how have you been feeling I'm good so tell us what I take so I'll be honest with you I used to be a bad crackhead I used to smoke crack I smoked crack for every day for 6 years but when I had that heart attack it's made me change my hospital 8 weeks ago yes and you had the clots in your lungs and a bit of inflammation in your heart yeah yeah but I've changed my life since then good for you but but I did mess up once in 8 weeks the other day do you know what I mean mhmm I smoked it only a little bit but I'll I'll beat myself up about it but my anxiety levels are bad mhmm of course and I don't know if it's worse because I'll stop doing that I've got certain situations where my children you know they're a smoothie crack oh good now in a situation they can't get out of I've got 1 kid that wants to get out of it 1 kid because he you see what one's gonna wanna do you know what I mean I've been in so sorry you must be so very sad I've got certain my partner's just got out of jail today okay so I've got anxiety around that so anxiety around different things that's going on of course I've got pressure from my partner oh I'm sorry sounds like you've got so much wrong sweating so much time I just and I'm also having anxiety mhmm but it's bad it's really bad awful yeah and it's making me have pain here yeah it's where I'm crying as well and I'm straining it I look angry mhmm all day yesterday I was anxious the night before I didn't see fever I didn't sleep last night because I can't sleep when I'm anxious I understand do know I mean I've got 1 son that's telling me because he got children and he 1 son telling me that he feels that he's just in a position in a minute he just wants to end it so I've got thought them thought is what they're saying to me you've got to mad and I feel like I've always been there for my oldest 2 children always you know what mean even though I've done what I've done and they always say to me mom you've always been there for us you do what you can for us you know and they tell me they tell me they're telling me and that but it's so hard to see your children in that situation because they would never be in that situation if it went for me in the I'm not saying I've ever wanted them to smoke I haven't of course not but their dad I'm just different their dad would count really that's who they live with okay and he just put in the room put his toes down and I'm in front of him of course you what I mean but like it's just my anxiety around everything and it's affecting my heart I can feel it can I feel it you know and now it's like I'm worrying about my heart you know I mean I've been worrying about my copd and managing that you know what I mean for years since I've been diagnosed and then the medications the pimps I should be on now mhmm it's now this going on and obviously coming off the clicking doesn't help yeah no it's me feel terrible yeah it does because I've got all of my emotions as well and everything going on as well feeling shaky and tremulous because of it oh I'm sorry yeah it's not anxiety I can feel for so that as you get some palpitations yeah I can feel it feeling it's rattling it feels horrible it feels like it's clicking it's hard but I can't I can't explain it and then I get pain and then the pain yeah when did the pain start yesterday okay early yesterday I'm booked down to the pharmacist because I pick up my subutex right from the chemist every day mhmm I've got go and get my subutex today but I booked down in front of her because I was so anxious yesterday of course all day and does the subutex help at all no because I've been on I'm on them you were on them before heroin use you what I mean I see right because I was on heroin years ago you know oh goodness but it's I just I don't know what to do sounds very difficult I know and I'm just worried I ain't gonna be it how long ago you feel like that you know I mean I'm sorry I know at 1 son he's got really bad mental health with all big doctors with him they done referral to mental health team yeah and he's in a relationship he should be in a relationship because he's dangerous to women and in a minute I could just see it ending 1 way he's going back to prison oh god obviously 1 side ended up in jail for a long time and I've seen my husband doing it in a minute he's in the trap you know what I mean he it's hard because I lived there for years I've done that so I know exactly how he's feeling at this minute mhmm and even though when he gets paid he doesn't wanna spend all his money on it he's in the house and he you can't have it when you're the in house when it's around of course you know I mean so I'm I'm watching my sons basically hurting their legs you know what mean they have been for months now it must be awful and do my all do my you know and I haven't even seen my partner yet and I've told him I don't want him coming up here you know I didn't even see him that's how anxious I am and he's not horrible to me it's just he put pressure on me as well well you know we're not touching the crap and I just said to him stop telling me I'm not touching it because I don't wanna touch it but I'm doing it do you what I mean so he's stop putting pressure on me you know and and then thinking back about the pain in your chest when did it start this time yesterday that afternoon yes they are yeah and it's a pain here on the left hand side it's I go I'm getting ear mhmm I'm getting it and I know that's the muscles around my heart because that's where I both sides yeah it's more on this side more on the left and I've got swelling here okay but my copd blamed me up and that had pain me up for weeks you know mean is that is that worse my lungs are a bit sore painful yeah not bringing that thick mucus know what I mean that's all the mucus it's green green and some of it's white has some of that changed yeah has it got it's got more blue it's not chest no I've got chest infection I know I definitely haven't got chest infection after the chest infection and that's what the doctor thinks triggered this and do you have any fevers I had a chill yesterday did you and I had I had a bit of a cold I could I feel I feel a bit bugged up now yeah you know I mean I can't breathe from my nose properly mhmm and I had a cold for a long time you know what I mean mhmm and a chill I had a chill yesterday I actually got in the quilt and I'll never get in the quilt you know because obviously I can't get hot and that you know yeah of course fine so you had a bit of a shaky episode yeah okay may have been feverish then yeah and the your your coughing sputum has changed but you don't think you've got a chest infection why don't you think you've got a lot of chest infections and I I well she'll be eating brilliant because I've been taking all my tablets probably all my carbocysteine tablets yeah and my blood thinners and do do you you have a sore throat at all or anything no no no sore throat okay so even around my shoulder blades are right in that as well you know muscles are aching yeah muscles yeah mhmm yeah and your so your your scan that you had when you were in hospital the mri scan of your heart showed that there was some inflammation in the heart a myocarditis that's inflammation in the muscle of the heart you had that test to look at the vessels around the heart that was very reassuring entirely normal and he said the doctor said he said some thingy he said your heart has repaired itself in the 2 weeks you've been in hospital you know what I mean but since I've been out of hospital there's a reason to just say I've had the pain but the anxiety is bad you know mhmm and did the pain come on after you used the crack yes as well there's was that that day that you used the crack that the pain came on no no next day yeah so you used the crack after the pain I said I was already going through the anxiety anyway I understand just because sometimes the pain can cause of yeah I always say I rush when I smoke crap you know mhmm that's why I don't wanna put it away arm hurts yeah I understand no I can have a? But that'll kill me mhmm you know I mean because your heart rate is you know of course can I have a look at you do you mind if look at your hands and listen to your chest you don't have take anything off no I'll just look at your hands to start with that's okay very much I can't seem to put on weight but mind you I don't eat but they put me on their menstruals but I don't seem to be putting it on really I think not using the the crack will really help yeah because obviously as you know your heart races it brings your metabolism up and you burn a load of calories I mean time you know but eating is important no I I live on it but no no but I've always told them I'm eating anyway you know in what way do have an appetite no I've never really had an never really I have an appetite yeah never been wanting sit down and eat 3 meals a day you know really no never even that feels clear although I just got infection to your heart so that's a tip some big breaths right here yeah my muscles are sore now oh sorry I'll be gentle oh that's better I'll breathe take deep yeah you don't have to breathe too much can make a sore that's the thing and I'm even like I've cut down my cigarettes are even I'm on different patches now you know mhmm I'm on a 25 mg 1 I've gotta get a new prescription you know yeah but I've even cut down the flags as well difficult isn't it yeah so you're when you were in hospital the markers of heart damage were very high which is why we brought you into hospital yeah explained yeah 1,300 very high exactly yeah so they were up here yeah now they're down here they're normal oh brilliant both tests are normal which is good we've also tested you for a blood clot around the lungs which is also normal oh lovely but your full blood count looks like you've got a viral infection so the lymphocytes which are the cells that fight a virus are up tablets for I just found out what hepatitis yeah and you've got hepatitis c yeah and you're on some tablets for it I wouldn't usually expect that to put your lymphocytes up like this no but I said to him my liver was short yesterday really short mhmm I said to him that about that but I just thought it's a tablet's wagging yeah of course it was out in the whole year yeah okay on your back all in my kidney because I I've got 1 kidney have you yeah okay but I know when it's your kidney because I suffer with pain on my right side before but I tell you that I see okay I wonder whether you've got an inflammation around the heart because of a virus and that can happen that can cause these very high levels that then spontaneously resolve yeah and it can persist for some time and cause heart pain like to speak to the specialist heart doctors to did see know I they had a couple of shooting pains through here did you yeah I got a bit worried and called the nose over because I was I was saying to her 10 before that it had calmed down mhmm I see you know then all of sudden because it's swelling here inflammation all here mhmm yeah but if you feel it you can you're all inflamed okay well think what I should do is speak to the specialist doctors who looked after you while you're in hospital the cardiologist and see what they think and give them and they'll hopefully give us a bit of an idea about whether this is viral myocarditis and if it is what we should do to treat is that hard also be sweating a lot bad bad I hate it because it's embarrassing being out I'm literally dripping wet dripping sweating a lot and you had a right way dripping off me yeah okay you know I mean cool thing yeah fine okay well let me go and speak to them I'll put them back in the waiting room I'll go and chat to them and then we'll work out what symptoms are okay yeah thanks for telling me I know there's a lot going on yeah okay and get you feeling better and work out what's going on yeah amazing no worries I'll I'll be okay okay I'll give you a call