obesity, a previous MI, heart failure, cardiomyopathy, carotid artery syndrome, ventricular tachycardia, hypertension, and hyperlipidemia. Patient is also a chronic smoker with nicotine dependence. Patient has a left chest wall pacemaker. Vitals: BP: 137/96, Pulse: 98, 280lbs, BMI: 41.3.Patient has a faint wheezing and diminished breath sounds but has no signs of peripheral edema.AssessThe most important thing for this patient is getting him adherent on his current regimen. He is having multiple symptoms but I would not recommend any changes until he is adherent and is able to properly determine the efficacy of his medications. I would recommend continuing to monitor his electrolytes as he is currently taking Losartan, Potassium and Spironolactone all of which have an effect on his potassium levels. I would also counselon lifestyle modifications such as a healthy diet and smoking cessation to help his heart health outcomes. Finally I recommend possibly adding an anti-depressant to help manage his depression but this maybe appropriate at a follow up appointment once his current drug regimen is optimized.
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