the patient i saw today reported chest pain had complaints about pre syncope could not tolerate physical activity had palpitations was short of breath symptoms started two months ago she had palpitations wheezing dyspnea orthopnea and lower extremity edema  misses palmer is currently taking lisinopril and prednisone her blood pressure was one hundred and fifty she had a heart rate of one hundred and thirty beats per minute her respiratory rate was over twenty five and her oxygen saturation was below ninety two percent she claimed she was fatigued and had weight gain upon inspection i observed no carotid bruit jvd present pmi normal inspection she had regular rate and pedal edema in lower extremities her calf was non tender murmur present rales s four and no chest wall tenderness looking at the diagnostic labs misses palmer did not elevated bnp ekg xray ap chest 2d echo sinus rhythm normal axis she had mediastinal fullness pulmonary edema and increased wall thickness all findings indicate  sarcoidosis restrictive cardiomyopathy with a nyha three she will be on dvt prophylaxis daily weight and oral fluid restriction i will consult the cardiologist and hospitalist	she will be put on furosemide aspirin hydralazine to manage heart congestion and a low sodium diet and nasal cannula to manage respiratory rate
