56   years 
DM   fOR THE LAST   16  YEARS  GOUTY ARTHRITIS 
hTN FOR THE LAST    4  YEARS 
DLD

HE WAs  DOING WELL   UNTILL    3  MONTHS    WHEN HE STARTED TO HAVE  LOWER LIMBS SWELLING AND HE  HAD  ECHO  T [vHAT SHOWED  NORMLA 
HE  SOUGHT MEDICAL DVICE  AT  DR  HANI 
 AND  HE   SOUGHT MEDICAL  ADVICE  BY  DR  MALEK 

HE   WAS  DOING   CREATININE  WAS 1.2 

ECHO WAS DONE AND  SHOWED    EJECTION FRACTION  55%
DIASTOLIC  DYSFUCNTIO   GRAD  1 
MILD  CONSEBTRIC  LVH


MEDICATION 
COIDIOVAN   160/25
LOZAR??
LASIX 
EUCREASE
TEGRETOL
ENALAPRUL
ASA
VALSADIPIN HCT
ASA  100 MG ONCE 
ATOZT?? 
FLICTAMET     10/1000


plan 
hold  valsadipin  hct 
hold inflictamet 
start amicor 
cadex 
asa    janeut 
tegretoil 
crestor 
rtc after   one week 