Problem:
Chief Complaint: A 66yo women presents to urgent adult care with c/o SOB and burning sensation in upper abdomen that extends to her back. The patient has had difficulty in sleeping over the past five nights and reports being tired more than usual. She is a retired office worker who smokes 1 ½ packs day and drinks socially. Her BMI is 33 and she has been taking captopril an (ACE inhibiter) to control her BP but she ran out of it 2 weeks ago and has not refilled the prescription. Physical Exam: vs t 98.8, P 88/min and regular, BP 150/ 104 RR 24 Saturation 92% PE : Pt is pale and diaphoretic. Neuro exam: no focal deficits CN 2-12 intact, anxious. Heart sounds S1 and S2, no murmur S3, S4. PP, no edema, No JVD, PMI laterally displaced to the left and >2.5cm, No lymphadenopathy, no carotid bruit.