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I.

DISCHARGE SUMMARY

Name: Dr.Sundeep Bajpai Age: 39 Years Sex: Male Central Regn. No.: 00057098 Cardiac CI.No.: 29988 Ward : PORR Bed No. 1 Date of Admission : 17/10/2016 Date of Discharge: 24/10/2016 Cardiac Surgeon : Dr.O.P. Yadava

Cardiblogist : Dr.Vinod Sharma

Date Of Operation: 19/10/2016

Diaanosis Coronary Artery Disease Severe Single Vessel Coronary Artery Disease Recent anterior wall MI Post PTCA with Stenting to LAD (Stent Rethrombosis) Post POBA to LAD with thrombosuction Moderate LV dysfunction

NIDDM, Systemic hypertension

Coronary Artery Bypass Grafting x 1 (off pump) Pedicled LIMA - LAD

Operation

Brief Clinical Summary

Dr.Sundeep Bajpai, 39 years old pleasant orthopedic surgeon, suffered from Non-STEMI on 26/09/2016 for which primary PTCA with Stenting to LAD was done. He suffered from anterior wall MI four days later for which repeat angiography was done which revealed stent thrombosis. Immediate POBA to LAD and thrombosuction was done on 01/10/16. However he had a recurrence of angina a week later for which he required repeat angiography. This showed total ocdusion of LAD (instent restenosis). Coronary risk factors are diabetes mellitus, systemic hypertension, cigarette smoking and obesity. He was taken up for surgical Intervention as• a high risk case with informed consent.

Pre. Operative Medications

Tab.Rosuvastatin 20 mg 1 OD Tabismo 10 mg 1 OD Tab.Pantocid 40 mg 1 OD Tab.Carvedilol 1 BD

dyjoi

Low cholesterol, high fibre, diabetic diet Tab.Pantoprazole 40 mg - one tablet once a day before breakfast for seven days

(8AM) Tab.Isosorbide Mononitrate 10 mg - one tablet twice a day (8AM, 4PM) Tab.CloPidogrel 75 mg sone tablet once a day ifter evening meal (10 PM)

Tab.Soluble Aspirin 350 mg — 1/2 tablet once dday after: evehing meal (10PM)

Tab.Rosuvastatin 20 mg - one tablet once a day (10PM) Cap.Tramadol 50 mg - one capsule as and when required for pain (To a maximum of 3

capsule in a day and shoUld be taken after meal) ? I.

Tab.Spironolactone 50mg+Furosemide 20mg - tine tablet once a day (8AM) Tab.Carvedilol 3.125 mg - one tablet twice a day (9AM,9PM) Tab.Amiodarone 200 mg — one tablet once a day till next follow up with treating

cardiologist lab.Metformin 500 mg - one tablet before breakfast and one before dinner Tab.Fefol Z - one tablet once a day after meals for 10 days (11AM) No weight lifting and driving for four weeks. Daily painting of the wounds with Betadine lotion. Follow sternal precautions and Endocarditis Prophylaxis as explained Steam Inhalation and deep breathing exercises twice a day.

Daily bath • Mobilization allowed within the house and outside the house also. Kindly come two hours before the appointment time of next follow up visit to enable the following blood Investigation to be done:, Serum Electrolytes (Na+, K+), PPB5 Please report back in case of any bleeding, fever, difficulty in breathing, redness or

discharge from wounds. Please consult Diabetologist for management of diabetes mellitus.

Dr.Amita Yadav Consultant Cardiac Surgeon

PTePared by Drimtta

In case of an emergency please contact 24 HOURS Cardiac Help Line Numbers: 65 900 900 & 65 900 000 & Reception 9899774944

Oet I, 2016 3:57 AM

Oct 8, 2016 1:21 PM ANGIOPLASTY-SUR

ANGIOGRAPHY-SUR

YES

YES DIABETES MELLITUS

HYPERTENSION

1 ADJHN161000001

Printed On: May 9, 2017 3:30 PM

--fAYPEE GROUP

°JAYPEE HOSPITAL LIFE FIRST

inef

DISCHARGE SUMMARY

JHN000134344

6071-DELUXE

DUBEY NURSING HOME SHINDE Xi CHAWNI GWALIOR MADHYA PR ADESH INDIA

AD 1STEMI (26.09.2016) 'TGA + stent to LAD (26.09.2016) \ cute anterior wall MI kcute occlusion of LAD stent (30.09.2016) 'OBA to LAD with thrombosuction done on 01.10.2016 vloderate LV dysfunction - LVEF 35%. )iabetes mellitus. lypertension

1-'9.4,64-:,,e',01r_itd t:gy Dtkri ws.:, i?,1..iii7A1W - _,...;,„,......,.,

Dr. Sandeep Bajpai, a 39 years old male patient hypertensive, diabetic suffered NSTEMI on 26.09.2016. CAG was done at Gwalior which showed SVD. PTCA to stent to proximal LAD was done and patient was discharged on 28.09.2016 after stabilization. Patient developed acute onset chest pain again on 30.09.2016. He was re-admitted at Gwalior and CAG done showed subacute stent thrombosis, PTCA + stent to LAD was done and another stent overlapped. In post procedure period patient developed chest pain and he was brought

to Jaypee Hospital for further management.

. .

Helpline 1800 102 9 103

• Regd. & Corp. Once: Jaypee Healthcare Ltd.. Wish Town. Sector - 128. Noida 201304. Uttar Pradesh. India

Ph: +91 (120)4122222. Fax: +91 (120) 4582899 ON U85191UP2012PLC05335 'd

Email: askusgjaypechcalthan exam. LVcbsile. Prow.jaypeehealthcare .coh)

NABH

' Lab. Investigations: Pre Operative At discharge

Haemoglobin (gm%) 12.5 8.9 RBS (mg/d1) 145 114 Blood Urea (mg/di) c 20 21 S. Creatinine (mg/di) 0.7 0.7 S. Sodium (mEq/L) 138 138 S.Potassium (mEq/L) 4.4 4.2

Echocardiogram

LV mildly dilated. Moderate LV dysfunction. LVEF 45% Distal4/2 of anterior NS & apex akinetic. Distal 1/3 of anterior & lateral wall hypokinetic No pvicardial effusion or LA dot

Coronary Angioaratthv :

Severe Single Vessel Coronary Artery Disease with Moderate LV dysfunction (Detailed report with the patient). •

Operative Procedure (19/10/2016) : Coronary Artery Bypass Grafting Surgery was performed on beating heart (without CPB). He received 1 graft. He tolerated the procedure well and the surgery was performed uneventfully. He was shifted to the Recovery Room with stable haemodynamics with 5mcg/kgimin of Dopamine/NTG. (Detailed notes with the patient).

Post Operative Course:

He was extutiated the same evening. He was mobilized on second post-operative day. His post operative course was uneventful.

Condition at the time of discharge:

His wounds are clean and dry. Sternum is stable and chest is clear to auscultation. There is no pedal edema. He is afebrile and fully mobilized. His chest X-ray is within normal limits. His lab investigations are within normal range.

Fjgovas

Next follow up with Dr.O.P.Yadava after one week on a following Saturday with prior appointment from Mr.Kishan Kumar Dutt, Executive Secretary on NHI Telephone No.

79-§3 (Direct), 6606.0074Millfili (between 10:00 AM to 4:00 PM). He is referred back to trdating cardiologist with thanks, for further follow up and needful.

20

100

Respiratory Rate SP02 (%)

(per min) ikr min) BP (mm of Hg)

105/63

Printed On: May 9, 2017 3:30 PM 2

ADIHNI61000001

AYPEE GROUP

Rtgd. & Corp. Office: ffiypee Healthcare Ltd.. Wish Town. Sector - 128. Nokia 201305. Oily Pradesh. hide(

Ph: +91 1120)4122222. Fat +91 (120) 4582899 UN Li851911.1P2012P1C05335L

Email: askus@jaypeehealtheare.com. Website. umv.iaypeehealthearc .com NABH

+

VP : Not Raised

tESPIRATORY SYSTEM

Murmur: Nil

Pedal Edema: Not Pres6t

:leer

'Cr Abdomen

.iver: Not Palpable

ipleen: Not Palpable St

)r. Sandeep Bajpai, a 3.9 years old male patient hypertensive, diabetic suffered NSTEMI on 26.09.2016. CAG was done at Gwalior vhich showed SVD. PTCA to stent to proximal LAD was done and patient was discharged on 28.09.2016 after stabilization. Patient leveloped acute onset attest pain again on 30.09.2016. He was re-admitted at Gwalior and CAG done showed subacute stern thrombosis, ?TCA + stent to LAD was done and another stent overlapped. In post procedure period patient developed chest pain and he was brought o Jaypee Hospital for further management: Check Angio revealed subacute stent thrombosis stent 10D% block and 95% lesion in large DI with slow flow and thrombus burden. Patient was taken up for high risk angioplasty with IABP standby. PTCA / POBA to LAD was ione using GPIlb/Illa inhibitor. Thrombosuction was done with thrombuster. ECG revealed ST elevation with wide QRS tachycardia. Patient was stabilized and put on ionotropic support, cordarone, tuniplatelets and other supportive management. 2 El Echo revealed RWMA, LAD teritorry with LVEF 30-35%. In post procedure period patient was stabilized medically. Check CAG done on 08.10.2016 showed proximal 100% instent occlusion (SAT in proximal stent), Distal LA]) is filling retrogradely by type II collatemls of RCA and

LCx. Now the patient is stable and is being discharged with the following advice. .

Sinus rhythm, ST Elevation anterior leads with RBBB

LAD territory akinetic with LVEF 35%-40%

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MICROBIOLOGY

AEROBIC C&S URINE

AEROBIC C&S URINE

AEROBIC C&S BLOOD

18-24 his

18-24 his

5 days

No micro-organisms grown in culture.

Insignificant number of micro-organisms .girown in culture.

No micro-organisms grown in culture.

cerc5,110t9 114,619.0) Stable.

Regd. &Corp, OfRie: laypee Healthcare Lid.. Wish Town, Sector- 128. Noida - 201304.11W Pradesh, India

Ph: +91 (120) 4122222, Fax: +91 (120) 4582899 C1N: U85191UP201iPLC053358

---

Email: askus@jaypeehealthcare.com, Website: www.jaypeeheallhcare .com

SUNDEEP 13fik.wrsi

Rosuvas 20 mg once a day at 10 pm iPrasuvas 10 mg once a day at 10 pm Ecosprin 75 mg at bed time at 10 pm CremafTin 31sf at bed time as and when required. Sorbitrate 5 mg di a:s and whenrequired. Glycomet sop mg twice a day

o Pan 40 mg once a day b Monotrate 20 mg twice a day b Lasilactone 20/50 ltab once a day b Tachyra (Cordarone) 100 mg once a day

b Lithium 5 mg thrice .a day Lb Petril MD 0.25 mg *bed time ib Carca 6.25 mg twice a day

Cardace 1.25 mg twiee a day ib Dolo 650 mg as and when required ib Linid 600 mg twicea day for 7 days

Fondared 2.5 mg sic once a day for 7 days

tg/.21th?lis teview in OPD with Dr. Sanjiv Rhardwaj after 5 days with prior appointment.

n case you want to take an appointment please call on 01204122222 a day prior to your visit

Dr. Sanjiv Bhardwaj Associate Director Interventional Cardiology

DM (Cardiology)

•

Printed On: May 9, 2017 3:30 PM

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