Mr. Heldman is a 69-year-old male with end-stage renal disease on hemodialysis who presented to the emergency department prior to admission with shortness of breath and chest x-ray revealed pulmonary edema. On physical examination, vital signs were temperature 95.8, heart rate 74, and blood pressure in the right arm 134/62, HEENT was dentition without evidence of infection, no carotid bruit, cardiovascular was regular rate and rhythm, peripheral pulses were 2+the carotid, radial, and femoral and dorsalis pedis and posterior tibial were present bilaterally, respiratory rales present bilaterally, and neuro was cool extremities with monophasic pulse. An echocardiogram was done and it showed evidence of dehiscence of the bioprosthetic aortic valve with prolapse into the left ventricular outflow tract and at least moderate perivalvular aortic regurgitation as well as moderate to severe mitral regurgitation. Preoperative labs showed sodium 141, potassium 4.4, chloride 102, carbon dioxide 29, BUN 26, creatinine 5.8, glucose 195, magnesium 1.9, white blood cells 6.11, hematocrit 28, hemoglobin 9.5, and platelets 98,000. He was put on preoperative medications which included Labetalol, 100 mg p.o. t.i.d., amlodipine 10 mg p.o. daily, lisinopril, 20 mg p.o. day, Zocor 40 mg p.o. daily, PhosLo 1334 mg p.o. a.c. The patient underwent a replacement of #24 homograph, MVP with Alfieri suture, bypass time of 355 minutes and crossclamp time of 265 minutes. During the operation, one ventricular wire, one pericardial tube, one retrosternal tube, two left pleural tubes and two right pleural tubes were placed. He was discharged home on the following medications aspirin 325 mg p.o. daily, hydralazine 100 mg p.o. q.i.d., labetalol 100 mg p.o. t.i.d., lisinopril 40 mg p.o. b.i.d., oxycodone 5 mg p.o. q.h.s., losartan 100 mg p.o. daily and he will continue to be on both vancomycin and rifampin until 1/3/04, with the rifampin taken orally and the vancomycin after dialysis three times a week. His postoperative course was complicated by infectious disease and cardiovascular issues and he will follow up with the cardiac surgeon in six weeks, cardiologist in three to four weeks, primary care physician in one to two weeks, and cardiologist in two weeks.
Is the patient currently or have they ever taken phoslo
lisinopril, 20 mg p.o. day,