The patient was admitted to the emergency room by Dr. X. He has diuresed with IV Lasix.  He was placed on Prinivil, aspirin, oxybutynin, docusate, and Klor-Con.  Chest x-rays were followed.  He did have free flowing fluid in his left chest.  Radiology consultation was obtained for thoracentesis.  The patient was seen by Dr. Y. An echocardiogram was done.  This revealed an ejection fraction of 60% with diastolic dysfunction and periaortic stenosis with an opening of 1 cm3.  An adenosine sestamibi was done in March 2000, with a small fixed apical defect, but no ischemia.  Cardiac enzymes were negative.  Dr. Y recommended a beta-blocker with an ACE inhibitor; therefore, the lisinopril was discontinued.  The patient felt much better after the thoracentesis.  I do not have the details of this, i.e.