Good morning,  Mr.  Ramirez.  Based on  your  recent  vitals and the  symptoms  you  reported,  I'm  concerned  about  possible  cardiovascular  involvement.  Given  your  history of  hypertension  and  diabetes  mellitus,  we need  to  closely  monitor your  cardiac  function.  I  prescribing  metformin to  help manage  your blood  glucose  levels  more  effectively.  I  also  noted  episodes of  mild  tachycardia  during  your  physical  examination,  which  warrants  further  evaluation.  We'll  begin with a  baseline  electrocardiogram  to  assess for  any  arrhythmias or  ischemic  changes,  followed  by an  echocardiogram to  evaluate  ventricular  function and  valve  integrity.  If  the  findings are  inconclusive, I  may order  an  MRI,  an  MRI, or a  CT  scan  to  obtain more  detailed  imaging of  the  cardiac  and  thoracic  structures.  Additionally,  your cough  and  wheezing are  consistent with  bronchitis.  For  symptomatic  relief,  you can  take  acetaminophen  as  needed for  fever or  discomfort.  I'll  schedule a follow  up  appointment in  two weeks to review your test results and adjust your treatment plan accordingly. 