Referral letter to a doctor

Dr Issacson Cardiologist 45 Inlaermen street Caulfield 3162 19/01/2007 Dear Dr Issaacson, Re: Mr Jing ZU, 72 years of age. I am writing to refer Mr ZU, a 72-year-old man who presented to me with features suggestive of ischemic heart disease. Your further assessment and management would be highly appreciated. On 3rd January 2007, Mr ZU came with a complaint of angina. It became aggravated upon exertion likewise, gardening and relieved with the rest and an arginine. He slept with two pillows and had mild postural dizziness. On examination, his pulse was 84 beats per minute, blood pressure was 160/90 mm Hg in a lying position. However, in a standing position dropped to 145/80 mm Hg. His JVP was +3cm. On the chest auscultation, bilateral basal crepitations were heard. In the feet, mild ankle edema was noticed. Based upon the above findings, stable congestive heart failure and angina were suspected. On 15 January 2007, Mr ZU's all symptoms became worse. On examination, Blood pressure was 140/90 mm Hg, JVP +6cm and crepitations progressed up to the middle zones of the lungs. In addition, ankle edema progressed up to the knee joint. As a result, ECG was advised and the dose of Lasix was increased up to 80mg. On Today's visit, Mr ZU feels somewhat better. Yesterday, he had angina upon mild exertion. On examination, Juglar venous pressure(JVP) and blood pressure have improved. In ECG, Ischemic changes in the anterolateral wall of the myocardium have been seen. Mr ZU has been suffering from hypertension for 18 years, Ischemic heart disease for 10 years. He had suffered from myocardial infarction in 1999. He has been also suffering from congestive heart failure for 5 years. In the view of above, Your further assessment and management would be highly appreciated. For any queries, please do not hesitate to contact me. Your sincerely, Doctor