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Stendard Form 302 : ¢ . Rev. Pugust 1954 . & P byreey of the Budget . 7 : a. Cirevler A 32 . ‘ ' CLINICAL RECORD DATE OF ABMIESTON 3/29/65 NARRATIVE SUMMARY DATE OF DISCHARGE 412165 (Sign end dota at end of narrative) ” HISTORY: This 62 year old white male was admitted for medical evaluation at the request of the ©. «5 Immigration Service, Patient has s loug a history of arterfosclerotic heart disease with anginal episodes since 1948, Myocardial infarctions have occurred in 1949, 1954, 1955, 1958, and 1963, In 1957, the patient had an internal mammary artery ligation for relief of his ue anginal symptoms while at the Flower Pifth Avemue Hospltal, Since that time, : the patient has had several episodes of documented congestive beart failure with severe angina, He was first evaluated in this hospital in August 1960, . In 1962, while at this hospital, his medications included diabetic oral hypo- Tae glycemic agents, in addition to his digitalis and diuretic therapy, The patient's : anginal symptoms increased in 1963 with symptoms appearing after walking 1/2 block. _ In addition, the patient stated at that time he had frequent nocturnal angina, ‘ This pain was associated with shortness of breath and bilateral arm radiation and < was relieved by nitroglycerin tablets, During the patient's last hospitalization” _ in Sept. of 1963, he developed precordial chest pain while waiting for an EKG to |” be taken, This was followed by EXG evidence of currents of injury with transs —. aminase elevations occurring one week later. Impression of suspected acute myo- cardial infarction was made at that time, although there were no Q wave changes, Patient states that he presently has anginal sywptows occurring after walking _ and nocturnally, Patient has symptoms after eating a meal, st which time he is * ’ unable to walk for approximately 1-14 hours, Anginal pains also occur nocturnally and after the patient walks several blocks slowly unassociated with meals. Som, - datermittent ankle edema has been noted, At present, the patient is taking “st approximately 10-15 nitroglycerin tablets per 24-hour period, with relief of his | syoptomatology. , NUMBER OF DAYS HOSPITALIZED ° PHYSICAL EXAMINATION: Well nourished, well hydrated white male in . Bo acute distress, The patient is noted to aubulate slowly, Blood pressure 130/70; pulse 86 per minute, regular; respirations 16 per minute, H.E,B.N.T, - Pupils equal and respond to light and accommodation, Sclerac were clear, Wo lid lag or nystagms was present, Fundi were physiologic with minimal AV nicking present, The thyroid was not enlarged, There was no cervical vein distention or cervical adenopathy present, Lungs were clear to auscultation and percussion, except for some decreased breath sounds in the left base posteriorly, Heart revealed a regular sinus rhythm, A Grade I/VI ejection systolic murmir was present at the aortic area with no radia~-: . tion, The PMI was not palpable, There was no cardiomegaly to percussion, Heart « sounds vere generally decreased, A2 was greater than P2, Abdominal examination (Ure additional sheets of this form (Standard Porm 902} tf more space ts required) SIGNATURE OF PHYSICIAN Continued /a 6 PATIENT'S IDENTIFICATION (Fer typed or written entries give: Neme—lax, first, — * . muddle; erade; date; hecpisal or medical facility) GAMBINO, Carle . : USPHS Hospitel, Staten Island 4, Mew York oo. ae i . soe o A