Reference no: EM133802850

Question

Ella Roberts is a 70 yo woman with a significant history of GERD. She presents to the clinic today for a routine follow-up visit. The patient reports that over the past month she has experienced increasing episodes of post-prandial heartburn along with a variable degree of dysphagia. She has required daily use of antacids (in addition to her usual H2-receptor antagonist) for symptom relief. The patient also experiences frequent nocturnal awakenings secondary to epigastric discomfort despite sleeping with 3 pillows. She feels as if her frequent episodes of heartburn prevent her from doing routine activities and living a normal life. PMH: GERD x 10 years HTN x 30 years Paroxysmal SVT Hiatal hernia Atypical chest pain Postmenopausal since age 50 FH: Father died at age 68 from CAD; mother died at age 74 from DM; two siblings with "heart disease" SH: Patient is widowed and lives alone; she is a retired waitress and enjoys backyard gardening in the spring and summer months. (+) EtOH-history of "heavy" alcohol abuse in past; current alcohol consumption reported at 5 to 6 beers/week; 60 pack-year smoking history; currently smokes 1/2 ppd. MEDS: Verapamil 120 mg po TID Hydrochlorothiazide 25 mg po QD Famotidine 20.