Cardiology

Department of Cardiology
King's College Hospital ESS
02 March 2011
Dear Dr Mukhopadhyay


Lord Eric Avebury, DOB: 29-09-1928, Hospital No: D442931, NHS No: 4644474150
26 Hodden Road, Camberwell, London SE5 9LH
Diagnoses:
1. Peripheral Vascular Disease - EVAR
2. Maltoma excised by Mr Michael Marrinan in 2006
3. A Road Traffic Accident creating a Colonic Laceration requiring Laparotomy - 2001
4. Barrett's Oesophagus
5. Anaemia of unknown aetiology
6. GTN
Medication:
1. Domperidone 10 mg BD
2. Bisoprolol1.25mgOD
3. Ramipril1.25mgOD
4. Omeprazole 20 mg OD
5. CalcichewD3x1BD
6. Solifenacin 10 mg OD
7. Furosemide 20 mg OD
8. Amlodipine 5 mg OD
9. Simvastatin 40 mg ON
10. Zopiclone 3.75 mg ON

I met this gentleman in Clinic today with Dr P and he remains well in himself and reports improvement in his symptoms. He is not as breathless as he was, especially during the time of the EVAR.

I have explained the results of the 24-HR Blood Pressure monitoring, which showed an average reading of 136 / 59 mmHg with little variability throughout the day. His daytime average was 140 / 58 mmHg. This is in-keeping with the readings that our machines have recorded. It was 122 / 52 mmHg this morning. I have re-checked on manual reading and it is of similar values. I have explained that this may indicate that his home machine may be giving falsely high readings, and that checking that he has the correct cuff size may be the next step.

His CTPA report is negative for a pulmonary embolus, but it shows moderate emphysema, in-keeping with his past smoking history. He stopped smoking in 1976.

He continues to have claudication and has an appointment to see Mr R soon. He asked about carotid angioplasty for his stenosis, which is around 20-40%. We have advised him against this and feel that he would benefit more from tight control of his lipid profile. Please check his lipid panel and aim to reduce his Total Cholesterol to below 4.0 mmol / L and LDL to below 2.0 mmol / L.


He can continue his Bisoproloi, but if his BP is too low or if his claudication worsens, he should stop taking it.

We have discharged him from Clinic, as his blood pressure appears well controlled now, but we have informed him that he can ask for another appointment if there is anything he would like to ask us in future.

Yours sincerely

Dr C
Cardiology SHO
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