Kevin ramsdal 1 156447 past medical history yeah extensive cardiac history ongoing refractory angina coronary sinus so extensive cardiac history <\n> Inferior mi 2009 <\n> Pci to rca om and lad <\n> Significant diffuse lad disease not amenable to revascularization <\n> Coronary sinus reducer implant november 2021 <\n> Dddr permanent pacemaker <\n> Type 2 diabetes mellitus epilepsy hypothyroidism 56 year old man investigations troponin t is 5 eosinase and normal liver function tests show an alp of a 141 when it was previously normal but otherwise normal liver function tests crp of 3 urea 5.1 full blood count unremarkable chest x-ray yet performed most recent h b a 1 c is 58 millimoles per mole observations heart rate 60 sat's 92% on air blood pressure hundred and 28 over 85 hello I'm rob I'm rob your gastroenterology doctor I'm the medical registrar on today okay how are you yeah good how's the pain improved good I'm glad we haven't really done much for it have we no it's just there's some more oh we have pretty much yeah there was some the notes weren't clear about we'd started it or not good I'm glad yeah excellent yeah that's good we've least done something that's important and it's working it's working excellent we could we could up try trade it a bit if you're still in pain can't we yeah I've just put it up now oh I've got a pressure on the left a bit so like it's a bit of balance now brilliant are you happy for me to go up a bit more I've got just titrated by pain yeah we just wanna get you pain free don't we yeah yeah I think so so just keep telling us you're in pain and we'll keep tinkering with it when it's wrong yeah okay you're feeling nauseated or anything like that let's have a look it's been pretty have you been sick I've been sick good we can get you something for sickness because sometimes this stuff can make you feel nauseated yeah and the pain in the chest can make you feel it's sensitive but I've had a read about everything so I've been having a horrid time with it this heart stuff I'm sorry is it all night and the diet was what it is so or not it's on my mother's side of the family mhmm it's just weird but luckily none of my children have had to have problems good just like crohn's disease 1 of them but they are fine my youngest son is mhmm about when he was 16 died for me to shut up yeah well my thing yeah well yeah it's for the big guy yeah yeah yeah he's under 12 hours is he fine he's had 2 ops and I have to do a 31 there oh goodness but he might have to have the bag then that's not that's why he doesn't want of course not a week's death 39 32 years you're step 2 now yeah yeah that's good because he's got a family in no home he's got a partner but he he doesn't want children in case he passes you oh well that's what he's worried about well I told him to speak to you guys yeah at his appointment there's no clear genetic link yeah we know there is some heritability but there's no clear gene that we could test you know what I mean it's some people it passes on but other people it doesn't and it's impossible to know whether or the rate is quite low we say so don't just go on to your diet check and then worry about lofran yeah exactly we've got loads of medicine haven't we we can give people this is all my mum's side they've heart all died of heart attack mhmm sorry are you allergic to anything trauma trauma what happens if you have traumatized been all over the city okay a little bit yeah that sounds good to me but yeah it's coming down good and blood keep telling us you're in pain we'll keep titrating it we probably need to go to ccu to have this continue to see any place where you need to a bit of time do you have a done this no I'm not a better the nursing ratio for someone who will answer you when you're in pain yeah know yeah it's not necessarily a lot of conflict with the patient it's pain so yeah it's a pain that makes you have less chest pain is that think that's what we want yeah okay can I squish my hands and examine you yeah yeah yeah thank you some yeah that's to start with it's a lot yeah it's taken a big off and nothing like that 2 minutes later than some time who do live with at home my wife and daughter and is she still at home how old is she 26 sounds like you're ready to be rid of that yeah she just finished uni she's done 5 years at uni come back skin yeah yeah yeah recarding she's done no criminal work in her brain okay she's still skin mhmm so we know now you've got her to look after yeah nightmare what's she gonna do with her criminal or pubicry she wants to get in the cvs cool she's working for a domestic abuse charity I mean not even a charity yeah she wants to go to the cinema so yep I got to her I said don't forget who you want me to go to exactly so I have some money back exactly at first yeah yeah okay when did you last have an echo just few a few years ago yeah I thought I could see them oh wow yeah a few years ago because I had angina problem probably already can use it yeah yeah getting ready doctor's ringing symptoms now mean so no they're up they can do anything to fix them no there was that the same time you had oh no that was before you had the coronary sinus reducer yeah that worked that worked brilliant in terms of pain yeah for about 6 months that worked brilliant at that yeah yeah do you drink or smoke no cleaned any kind of crap gotcha that's great right I'll get everything sorted for you while I'm hospital in get you a drug check and all that stuff alright thank you that's it if you think of anything can come back and answer any questions about it brilliant thank you it's easy impression on stable angina plan number 1 admission to cardiology bed or ccu number 2 continue isoket infusion <\n> Number 3 morphine and antiemetic <\n> Next cardiology review monet to consider whether further optimization of nitrates could be undertaken <\n> Number next serial troponins <\n> Number next