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. 7 . - . 1 bow ee 4 . 4 an . Oo ' - | Standard Ferm $02 . ( J ee ba Lf ow Rev. Pugust 1954 . . . XL. . pet ao * Burceu of the Budget t hye : Cirevler A a CLINICAL RECORD DATE OF 4DM1iSs8ION 3/29/65 (Sign end date at end of narrative} are vi HISTORY: This 62 year old white male was adnitted for ave we medical evaluation at the request a Pavan bt am Oa -8 kien t® Lae 2 tone history of arterfosclerotic heart disease with anginal episodes since 1948, Myocardial infarctions have occurred in 1949, 1954, 1955, 1958, and 1963, In pot 1957, the patient had an internal mammary artery ligation for relief of his be anginal symptoms while at the Flower Fifth Avemue Hospital, Since that time, . . the patient has had several episodes of documented congestive beart fallure hee with sevére angina, He was first evaluated in this hospital in August 1960. ae In 1962, while at this hospital, his medications included diabetic oral hypoe |... - glycemic agents, in addition to his digitalis and diuretic therapy, The patient's anginal symptoms increased in 19463 with synuptoms appearing after walking 1/2 block. In addition, the patient stated at that tine he had. frequent nocturnal angina, This pain vas associated with shortness of breath and bilateral erm radiation and - was relieved by nitroglycerin tablets, During the patient's last beopttaiistion 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 sywptous occurring after walking neue and cocturnally, Patient has symptoms after eating a meal, st which time he is © unable to walk for approximately 3-1k hours. Anginal pains also occur nocturnally: ‘oe intermittent ankle edema has been noted, At present, the patient is taking Te approximately 10-15 nitroglycerin tablets per 24-hour period, with relief of his ° _, Synptomatology. "PHYSICAL EXAMINATION: (Well nourished, well hydrated white male in Ro acute distress, The patient is noted to - aubulate slowly. Blood pressure 130/70; pulse — 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 préséat, Luugs were ciacar Se auscultation end prrtcuss.ca, SACePe 20, SU USls seers breath sounds in the left base posteriorly, Heart revealed a regular sinus rhythm, __ A Grade I/VI ejection systolic murmur was present at the aortic area vith no radia~-' — . tion, The PMI was not palpable, There was no cardiomegaly to percussion, Heart 7 o ' sounds were generally decreased, A2 was greater than P2. Abdominal exauination (Use additional sheets of this farm (Standard Form 302} if more space ts required) SIGNATURE OF PHYSICIAN Continued/a 2 PATIENT & TDENTIFIGATION (Fer iyped ov wristen entries sive: Naeme—iad, fret, = met . middie: grade; date; heupial or modtoel fecttty) , , 82389 =e cD2 "GAMBINO, Carle " . _—_— USPHS Hospital, Staten Tsiand 4m tow York be a . . wo v No® °. Qe al 3 q immigration Servics, Fatient has @ acug er ae and after the patient walks several blocks slowly unassociated with meals. Some, .: - 86 per minute, regular; respirations 16 per minute, H,E,E.N.T, - Pupils equal and acaaan os Tm as scat eatian and atuntsedan) @eneet Ene ans Asavesaned |.