text:  Aspirin 325 mg po q day . Vasotec 7.5 mg po q day . Humalog insulin sliding scale with meals and at bedtime . Humulin Walters insulin 24 units subcutaneous q A.M. and 8 to 16 in the evening depending upon where his blood sugar has been . Preoperative laboratory values were unremarkable . The patient underwent cardiac catheterization on 2011-10-17 which revealed a 20 left vein osteal lesion as well as 70 LAD lesion and an 80 right coronary . The patient was taken to the operating room on 2011-10-18 where he underwent an aortic valve replacement with 23 mm pericardial valve as well as coronary artery bypass graft times two with a LIMA to the LAD and saphenous vein to the acute marginal . Postoperatively the patient was transported to the cardiac surgery recovery unit on Milrinone   Neo-Synephrine and Levophed drip . The patient was weaned from mechanical ventilation and subsequently extubated on the night of surgery . He remained on Levophed   Milrinone and Neo-Synephrine drips and was hemodynamically stable . N. Saez clinic consult was obtained due to hyperglycemia and the need for insulin drip in the Intensive Care Unit . On postoperative day the Milrinone was weaned down . The Levophed had been discontinued as the Neo-Synephrine and the patient was beginning to progress hemodynamically . Upon discontinuation of the Milrinone the patient s SV02 had dropped significantly in the low 50 s. The patient had decreased exercise tolerance and therefore was placed back on his milrinone to keep his cardiac index greater than 2.0 . Over the next couple of days it was very slowly decreased as his Ace inhibitors were increased orally . The patient ultimately was weaned off the Milrinone   transitioned to Captopril on postoperative day five and remained hemodynamically stable . Once the patient had remained off of inotropics for approximately 24 hours   he had been given diuretics and Ace inhibitors and remained hemodynamically stable he was transferred from the Intensive Care Unit to the Telemetry floor on postoperative day six . A physical therapy evaluation was obtained for assistance and mobility . Cardiac rehabilitation was initiated at that time . On 2011-10-24 postoperative day six consultation heart failure cardiology service was obtained . It was their recommendation to continue Ace inhibitors   to continue daily weights   to switch the patient to a long acting beta-blocker and to enroll the patient in postoperative cardiac rehabilitation as well as to make sure the patient was on statin drugs . These measures were all instituted . The patient continued to progress from cardiac rehabilitation and physical therapy standpoint while on the floor . The patient remained hemodynamically stable over the next few days   continued to increase with physical therapy and ambulation . His blood sugars were followed by the Cape Cod Hospital Clinic service and insulin has been adjusted accordingly . Today   2011-10-31   postoperative day 13 the patient remains stable and ready for discharge to home . The patient s condition today is as follows  Temperature 96.9 F   pulse 84   respiratory rate 18   blood pressure 106  59 . Most recent laboratory values are from 2011-10-25 which revealed a white blood cell count 8.4000   hematocrit 35   platelet count 202 000. Sodium 133   potassium 4.4   chloride 93   CO2 30   BUN 24   creatinine 0.7   glucose 198 . The patient s finger stick blood glucose levels range from 151 to 390 over the past 24 hours and his insulin scale has been adjusted upward to compensate for that . Neurologically the patient is grossly intact . Pulmonary exam he is clear upper lobes   diminished bilateral bases left greater than right . Coronary exam is regular rate and rhythm . His abdomen is benign . His sternum is stable. His incision is clean and dry Steri Strips intact . His extremities are warm and well perfused with minimal edema of his left foot as well as his right stump . He is able to apply his prosthesis and ambulate as well .