REASON
CHIEF COMPLAINT: Heart failure. Coronary artery disease. Atrial flutter.
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This patient had an acute MI _____ and underwent three vessel coronary artery bypass grafting at that time. He states he had a cardiac catheterization elsewhere about four years ago and they did not perform any intervention at that time. He has had a transthoracic echocardiography and stress nuclear imaging test that has shown EF of 40%. His last nuclear imaging test showed only mild inferior ischemia and fixed LAD infarct 01/04/2017.
The patient was admitted to Granville Hospital 01/11/2017 with heart failure and at that time the EF was stated to be 25-30%.
He has been in intermittent atrial flutter for some time. The chart says that he has had atrial fibrillation but the only ECGs I can find were where his SVT show atrial flutter with a controlled ventricular response.
Patient states he has gained about 25 pounds in the last two months. …show more content…
He is too fluid overloaded to tolerate cardiac catheterization at this time. Please set up a followup appointment with Cardiology Clinic after a month when he has lost 10 pounds so we consider cardiac catheterization.
4. Please order a 24 or 48-hour Holter monitor so we can look at the atrial flutter burden but also determine whether he is going in and out of atrial fib, atrial flutter. If he only has atrial flutter then we could consider an atrial flutter ablation.
5. Weight loss and low-salt low-carb diet were discussed with the patient at length and the critical importance of using his CPAP machine every time he goes to sleep. 6. If you cannot obtain adequate diuresis with p.o. diuretics you may have to use IV diuretics. If that is unsuccessful he will need to be hospitalized at Duke Regional Hospital for IV diuresis and tune-up for cardiac catheterization and possible atrial flutter ablation.
7. Consider using something other than metformin for diabetic control because of the concomitant heart
CHIEF COMPLAINT: Heart failure. Coronary artery disease. Atrial flutter.
BLANKLINE
This patient had an acute MI _____ and underwent three vessel coronary artery bypass grafting at that time. He states he had a cardiac catheterization elsewhere about four years ago and they did not perform any intervention at that time. He has had a transthoracic echocardiography and stress nuclear imaging test that has shown EF of 40%. His last nuclear imaging test showed only mild inferior ischemia and fixed LAD infarct 01/04/2017.
The patient was admitted to Granville Hospital 01/11/2017 with heart failure and at that time the EF was stated to be 25-30%.
He has been in intermittent atrial flutter for some time. The chart says that he has had atrial fibrillation but the only ECGs I can find were where his SVT show atrial flutter with a controlled ventricular response.
Patient states he has gained about 25 pounds in the last two months. …show more content…
He is too fluid overloaded to tolerate cardiac catheterization at this time. Please set up a followup appointment with Cardiology Clinic after a month when he has lost 10 pounds so we consider cardiac catheterization.
4. Please order a 24 or 48-hour Holter monitor so we can look at the atrial flutter burden but also determine whether he is going in and out of atrial fib, atrial flutter. If he only has atrial flutter then we could consider an atrial flutter ablation.
5. Weight loss and low-salt low-carb diet were discussed with the patient at length and the critical importance of using his CPAP machine every time he goes to sleep. 6. If you cannot obtain adequate diuresis with p.o. diuretics you may have to use IV diuretics. If that is unsuccessful he will need to be hospitalized at Duke Regional Hospital for IV diuresis and tune-up for cardiac catheterization and possible atrial flutter ablation.
7. Consider using something other than metformin for diabetic control because of the concomitant heart