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Hospital Discharge Report
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Synthesis
STEMI, treated with PCI
Hospital course note
Dear colleague, I am writing to inform you regarding our mutual patient, a 69-year-old
male admitted on 06/10/2014 with acute chest pain and dyspnoea. On admission, ECG
demonstrated ST-segment elevation in anterior leads, and troponin levels were significantly
elevated, confirming an acute anterior STEMI. The patient was immediately transferred
to the cardiac catheterisation laboratory, where coronary angiography revealed significant
occlusion of the left anterior descending artery. Successful percutaneous coronary
intervention (PCI) with drug-eluting stent implantation was performed with good angiographic
result. Post-procedurally, the patient remained haemodynamically stable. Echocardiography
showed mildly reduced left ventricular function with anterior wall hypokinesia. Dual
antiplatelet therapy, beta-blocker, ACE inhibitor, and statin were initiated. The
patient was discharged on 07/10/2014 in stable condition. Please ensure medication
compliance and arrange cardiology follow-up within four weeks.
Medications
| 2014-10-06 | - | - | - |
Diagnosis at Discharge
| Acute transmural myocardial infarction of anterior wall | 07-Oct-2014 | active |
Significant procedures
| Antiplatelet therapy initiation (dual antiplatelet) | 06-Oct-2014 | - |