The patient is a 74-year-old male with a history of acute inferior myocardial infarction in February of 1998 and total occlusion of the mid circumflex with fresh thrombus, complicated by postmyocardial infarction atrial fibrillation with Mobitz type I block, now admitted following syncopal episode. At admission, the laboratory data was significant for a creatinine of 1.6 and a potassium of 5.1. Blood count was normal, CK 39, and cardiac Troponin I 0.02. The patient was loaded on procainamide and MEDICATIONS ON ADMISSION included Aspirin 325 mg q.d., Captopril 75 mg t.i.d., NPH insulin 18 q.a.m. and 8 q.p.m., Procainamide 500 mg t.i.d., and Simvastatin 20 mg once a day. The patient underwent evaluation for possible ischemic causes of an arrhythmia and was initially ruled out for myocardial infarction by serial enzymes and electrocardiograms. On standard Bruce protocol exercise tolerance test mibi, the patient went four minutes and thirty seconds, with maximum heart rate 121 and maximum blood pressure 210/85. He had typical chest pain for angina and chest tightness at peak exercise which was relieved with rest. The mibi images showed a mixed MI in basilar half of the inferior wall and mild peri-infarct ischemia in 3/20 segments in the right coronary artery territory. PAST MEDICAL HISTORY included Coronary artery disease, Diabetes mellitus on insulin, Hypertension, Status post bilateral knee replacements, asbestos exposure, and chronic renal insufficiency. The patient underwent cardiac catheterization which revealed a normal left main, left anterior descending artery with minor irregularities, left circumflex with 90 percent in-stent restenosis in proximal segment with a dominant left circumflex, and right coronary artery with a mid 50 percent lesion. He underwent successful percutaneous transluminal coronary angioplasty of the in-stent restenosis and was subsequently continued on aspirin. After the procainamide was held, the patient underwent electrophysiology study revealing normal sinus node recovery time, impaired AV nodal conduction, no inducible sustained ventricular tachycardia, and no inducible supraventricular tachycardia or atrial fibrillation. The patient was discharged to home with plans to follow-up with his primary cardiologist, perhaps with a Holter or event monitor and was prescribed Aspirin 325 mg q.d., Captopril 75 mg t.i.d., NPH Humulin insulin 18 units q.a.m. and 8 units q.p.m., nitroglycerin sublingual tablets, Vitamin E, and Simvastatin 20 mg q.h.s. The patient will be followed up by his primary care doctor, in particular the posterior cervical single lymph node should be followed up by his primary care physician.
What is the current dose of simvastatin
Procainamide 500 mg t.i.d., and Simvastatin 20 mg once a day.