Mar 12, 2026 11:58 To: +16042339777 Page: 28/46 From: Foremed Medical Clinic Fax: 16043985614

FRASER HEALTH AUTHORITY Emerg Note
Royal Columbian Hospital HOLAND,MARK THOMAS
RC0161840/25
| Temperature '36.5C | 19/05/2025 08:25 |
_ Temperature Source | oral _ 19/05/2025 08:25 |
_ Pulse Rate L59L _19/05/2025 08:25 |
_ Respiratory Rate | 16 | 19/05/2025 08:25 |
Blood Pressure | 125/74 | 19/05/2025 08:25
_Blood Pressure Mean | 91 __ 19/05/2025 08:25 __
| Pulse Oximetry 195 _ 19/05/2025 08:25 |

Documentation

HPI:

Mark is a 46yo male who presents to the RCH ED for a 2-week history of presyncope and
hypotension, and a 2-day history of chest and epigastric pain. In March 2022, he had a massive
upper GI bleed due to a duodenal uicer believed to be secondary to NSAID use, requiring IR guided
embolization.

He has had dizzy spells at least once daily for the last 2 weeks, where he has palpitations and feels
lightheaded upon exertion or with transferring from sitting to standing. His symptoms are relieved
with sitting down and taking a few sips of water. He measures his blood pressures which have been
as low as 98/58. He completed a 24-hour Holter monitor last week, which returned normal. He
endorses that his baseline blood pressure is around 110/70 and his baseline heart rate is 50-60bpm.

His chest and epigastric pain started 2 days ago. He describes intermittent warm, sharp pain to the
lower left chest. It is worse after eating, especially spicy foods, and relieved by sitting up. He denies
any squeezing, tightness, or radiation. He denies any frequent NSAID use, but endorses that he was
ona migraine medication from Mexico for 1 month which had both aspirin as one of the ingredients.
He discontinued this medication 1 week ago. He has minimal alcohol intake, endorsing 1 beer per
week. He denies any recent illness, dyspnea, fever, nausea, vomiting, abdominal pain, diarrhea or
constipation.

Past medical history:
Chronic spontaneous urticaria
Migraines

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Meditech Report iD: 1905-00211 2of4

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