65 years old male ot 
knonw to have   hypertension 
ihd   s/p  c cath  7/2023   after  ACS 
14/7  /2023 melena   upper  git bleeding 
dizziness   after the git bleeding while he was  at wedding t jordan 
fall down    due to hypotension > he was the   develped  vomting   tehn decrease level of consciousness 

jordan hospital >   ICU  
upper  endoscopy   and control of bleeding melena  
creatinine   1.6 mg  /dl 
he was  given   5  unite of packed  RBC    after  bloo    trasfusion 

net week  he was  doing well 


mri  shoulder was done for  right shoulder lipoma >> because it has  pain 
seen by dr mansour   for lipoma  resection 
28/11    was the appointemnet   but cncenlled due to   antiplateltwal( presugrel   and aspirin ) 
5/12     he had the operation    succesfully 
blood pressure w  montoring   135/80

medications 
presugrel  10 mg once 
atozet  80/10
nexium  40 mg ocne 
exforge   switched  to  norvasc    5 mg once 

creatinine   was done and showed  1.7 mg /dl

lm normal 
d1  noraml 
cx  normal 
rca   domintat and ectatic
pDA    stenosis  50% 
om   tight stenosis   and  DES  was  applied 

plan
add  deee dense 
make  nexium  40 mg ocne  
amicor  5  gm   1x2 
continue atozet    80/10 
presugrel   10 mg once 
stop  augmatin 
stop  ciprofloxacin