Note from Spencer Tilley, MD at 1991-10-14 00:00

Cardica Consult Dictated

74 year old white male with long history of cigarette abuse and Diabetes Mellitus insulin dependent for peripheral vasc operation in the morning.  Patient is sedentay and has no history of MI, angina, CHF, or cough.  Denies any symptoms of CHF.  Patient in need of operation to help nonhealing ulcer.  Only surgery is amputation of the leg on right.  No other serious med history

PE: Pleasant white male with NAD BP 140/60

P=76 R=20

decrease femoral pulse on right 

EKG- nonspecific ST changes

CXR- fitness right vascular, normal heart size

ECHO- TDS.  normal heart size, mild apixal hypertrophy

thick AV that opens well

DMP: 1) diabetes mellitus and amps

         2) peripherial vase dilation

         3) COPD

RTC: Patient has no symptoms of CHF or ischemia as diabetes may have silent ischemia and that is asymptimatic 

In view of good LV and in need of operation. Would proceed in the a.m. with OR, and use SL and line in  and Risks may be slight increase in secondary to age and operating is acceptable.  

Thanks, S. Tilley, MD

Signed by Spencer Tilley, MD at 1991-10-14 00:00