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SHADOW HEALTH -ANXIETY Chief Complaint Mr. Larsen is a 48-year-old White man who presented to the ED at 6 AM with a perceived cardiac complaint; he reports being exhausted, scared and unable to relax from last night. History of Present Illness Hx of HTN, hyperlipidemia, and osteoarthritis, presented in the ED this morning with complaints of exhaustion, anxiety, terror, and tachycardia which started last night 3 AM. Patient reports that the worry has been around since he was diagnosed with HTN (a year ago), but becomes worse last night. He states that he feels like he is choking, his body is sweating, shivering and he has been unable to control his fear since 3 AM. He says that he is scared about everything, especially his hypertension; he tried to take a deep breath several times to feel calm but did not work. He states that he came to the ED because he thought he was having a heart attack from his hypertension. He says that the anxiety causes him to skip work, prevents social interaction and that it affects his concentration and sleeping patterns. He denies any chest pain, fever, mood changes, or suicidal thoughts. Allergies Codeine Past Medical History HTN since age 47 Osteoarthritis since age 46 Hyperlipidemia since age 45 Past Surgical History Total knee replacement at age 48. Medication History Atorvastatin 20 mg P.O. daily for high cholesterol. Last dose: yesterday Lisinopril 10 mg P.O. daily for hypertension. Last dose: yesterday Fish oil 1 tab daily for high cholesterol. Last dose: yesterday Family History Mother, living, high cholesterol Father died of lung cancer, had HTN, deceased age 50 No known family history of mental illness Social History Employment: Currently employed as a postal clerk. Marital Status: Single, has no children, living alone. Tobacco: He denies past or present tobacco use. Alcohol/Illicit Drug Use: He drinks a beer or two on the weekend, he denies any illicit drug use. Review of Relevant Systems GENERAL: Fatigue, and diaphoresis. Negative for fever, night sweats, or purposeful changes in weight. RESPIRATORY: Shortness of breath. CARDIOVASCULAR: Palpitations. Negative for chest pain, or edema
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