CONTACTS
SUBJECTS
Coronary Artery Disease CAD Treadmill Stress Test Helter Monitor Hea
6703 -
6703 - ..
6704 - Summary/Objective
6705 -
670501 - Follow up ref SDS 83 0000. ref SDS 80 0000.
670502 -
670503 -
670504 -
670506 - ..
6706 -
6707 -
6708 - Progress
6709 -
670901 - Afib Test Helter Monitor Favorable Cardiology Recovery Heart Surgery
670902 - Helter Monitor Afib Test Favorable Cardiology Recovery Heart Surgery
670903 - Cardiology Recovery Heart Surgery Afib Helter Monitor Test Favorable
670904 -
670905 - Follow up ref SDS 83 OF8F, ref SDS 80 OF8F.
670906 -
670907 - During the meeting on 110309, Doctor Egan scheduled tests to evaluate
670908 - afib. ref SDS 78 OF8F He planned meeting again today to report on
670909 - assessment of test results, ref SDS 78 L33F,
670911 - ..
670912 - Today, request medical chart posted with...
670913 -
670914 - 1. Total distance and time of test.
670915 - 2. Beginning vitals..... BP and HR
670916 - 3. Ending vitals........ BP and HR
670918 - ..
670919 - Analysis.....
670920 -
670921 - 1. Helter monitor test on 110310 0930. ref SDS 79 OF8F
670923 - ..
670924 - 2. Stress test on treadmill on 110406 1230. ref SDS 83 OF8F
670926 - ..
670927 - Doctor Egan said the tests were very favorable for good coronary
670928 - health, showing no signs of heart disease nor diminished capacity of
670929 - any kind. He indicated these tests together with trends for lab
670930 - tests, reported from last blood test on 101207, ref SDS 63 RP4N,
670931 - indicate good cardiac health.
670933 - ..
670934 - Doctor Egan seemed to say the Helter monitor test found minor
670935 - irregular heart beat occurs infrequently.
670937 - ..
670938 - The doctor said that minor deviations from statistical "normal" heart
670939 - rates during stress tests are normal and expected for individual
670940 - genetics, and do not signal medical issues, relating to meeting with
670941 - Gisela, reported during treadmill stress test on 110406 1230.
670942 - ref SDS 83 IV6W
670944 - ..
670945 - [On 110520 1537 received medical chart for meeting today.
670946 - ref SDS 87 C39F
670948 - ..
670949 - [...below on 110415 0900 VA medical chart with findings of
670950 - "Abnormal atrial arrhythmia exercise," ref SDS 0 PYYS, for
670951 - stress test performed on 110406. ref SDS 87 EQ5L
670952 -
670953 -
670954 -
670955 -
670956 -
6710 -
SUBJECTS
Coronary Artery Disease CAD Aerobic Exercise Hiking 11-miles 2-times
8803 -
880401 - ..
880402 - Exercise Coronary Artery Disease Recovery Hiking
880403 - Aerobic Exercise Hiking Benefit Recover Coronary Artery Disease
880404 - Hiking Aerobic Exercise Benefit Recover Coronary Artery Disease
880405 -
880406 - Doctor Egan asked about level of effort hiking, discussed on 110309
880407 - 0900. ref SDS 78 6Z4N
880409 - ..
880410 - Advised have increased hiking with better weather since 110309, shown
880411 - in case study on 101010 0744, ref SDS 50 BT4L, and last week was able
880412 - to do 11-mile hikes, which is 4 laps at Lafayette Reservoir, and for 2
880413 - days in a row. ref SDS 50 UH6M This is a very significant increase in
880414 - aerobic exercise following heart surgery on 091022 0700. ref SDS 13
880415 - PQWU
880417 - ..
880418 - The doctor indicated vigorous aerobic exercise hiking 11 miles twice a
880419 - week significantly contributes to coronary health.
880420 -
880421 -
880422 -
880423 -
880424 -
8805 -
SUBJECTS
Coronary Artery Disease CAD Mercury Elevated Tuna Diet Test Ordered
A803 -
A80401 - ..
A80402 - Mercury Lab Ordered Evaluate Diet Tuna Salmon
A80403 -
A80404 - Doctor Egan concurred with Peggy's concerns about mercury from tuna
A80405 - in the diet on 74 of past 100 days, shown in case study on 101010
A80406 - 0744, ref SDS 50 2A5G Peggy presented mercury health risks from
A80407 - eating tuna regularly, reported in a letter on 110331 0138.
A80408 - ref SDS 82 TF6U
A80410 - ..
A80411 - Doctor Egan concurred with research at that time on 110331, showing
A80412 - tuna has many health benefits that prevent cancer, reduce cholesterol
A80413 - and blood pressure, which together lowers risks of coronary artery
A80414 - disease (CAD), including myocardial infarction (heart attack),
A80415 - reported in the record on 110331 0138. ref SDS 82 TG3T Myocardial
A80416 - infarction was cited as a patient risk in the VA medical chart for the
A80417 - meeting with Doctor Sandhu on 101223 1030. ref SDS 70 454F
A80419 - ..
A80420 - Doctor Egan seemed further to indicate the VA recommends eating tuna
A80421 - only twice a week for health benefits, while minimizing risks of
A80422 - mercury. He further noted that salmon has comparable health benefits
A80423 - but less risk of over exposure to mercury associated with tuna. This
A80424 - aligns with current practice of eating salmon at a reduced rate
A80425 - compared to tuna, since salmon is more expensive.
A80427 - ..
A80428 - There was not enough time during the meeting today for assessing
A80429 - harmful levels of mercury from eating small amounts of tuna daily.
A80430 - Some days may only have a few spoonfuls of food with ingredients that
A80431 - include tuna, illustrated by case study on 101010 0744. ref SDS 50
A80432 - H45G
A80434 - ..
A80435 - Doctor Egan asked why eat so much tuna and salmon with elevated
A80436 - exposure to mercury? What about steak, hamburger, chicken, pork, etc?
A80438 - ..
A80439 - Tuna and salmon avoid problems swallowing meat (e.g., steak, chicken,
A80440 - hamburger, etc.,), due to achalasia diagnosed at the VA on 051202
A80441 - 1430. ref SDS 1 0001 After initial treatment with surgery at SFMC on
A80442 - 091216 0600. ref SDS 29 KE8T, and follow up dilations by Doctor Lee
A80443 - here at the Martinez clinic beginning on 100305 1000. ref SDS 40 PR6P,
A80444 - severe swallowing problems continued, reported in case study on 101010
A80445 - 0744, ref SDS 50 BT8N Since tuna has health benefits, is easy to
A80446 - swallow, and tastes good in a variety of combinations, tuna has been
A80447 - eaten for lunch and dinner about 80% of the time this past year
A80448 - beginning on 101204, also reported in case study on 101010.
A80449 - ref SDS 50 189M
A80451 - ..
A80452 - As a result, Doctor Egan added mercury for the blood test in June to
A80453 - asses nutrition and risk of excessive mercury.
A80455 - ..
A80456 - [On 110429 1230 Connie in primary care scheduled blood draw
A80457 - for anytime after 110615; so planning on 110622; and Connie
A80458 - confirmed the lab will include Mercury, ordered by Doctor
A80459 - Egan. ref SDS 86 UN8N
A80460 -
A80461 -
A805 -
SUBJECTS
Cholesterol LDL 96 Goal 70 CAD Simvastatin 40 MG 6 Months Meeting Ro
AQ03 -
AQ0401 - ..
AQ0402 - Simvastatin 40 MG Lowers LDL 96 Over 50% Defer Simvastatin 80 MG
AQ0403 - LDL 96 Reduced Over 50% Recent Lab Nearer Good Health Goal LDL 70
AQ0404 -
AQ0405 - Follow up ref SDS 78 OF8F.
AQ0406 -
AQ0407 - The doctor noted LDL 96, on the most recent lab 101207, ref SDS 63
AQ0408 - E19L, remarkably dropped over 50% from 209 for the test 6 months
AQ0409 - earlier last July. 100721 0800, ref SDS 46 E19L
AQ0411 - ..
AQ0412 - Today, Doctor Egan discussed doubling prescription for Simvastatin 40
AQ0413 - mg to 80 mg per day, and in order reach goal LDL < 70, discussed
AQ0414 - previously on 110309 0900. ref SDS 78 ZM98 VA guidance seems to set
AQ0415 - <= 160 as a general target for good health, reported on 101207 0906.
AQ0416 - Earlier on 101227, VA medical chart assessment says LDL 96 is "at
AQ0417 - goal," ref SDS 70 TE49, and at that time, Doctor Sandhu discussed
AQ0418 - ending treatment with Simvastatin when LDL falls below 90. ref SDS 70
AQ0419 - XY9F
AQ0421 - ..
AQ0422 - Decided to hold simvastatin at 40 mg per day for another 6 months to
AQ0423 - see if this dose combined with continued exercise will reduce LDL to
AQ0424 - below 70.
AQ0426 - ..
AQ0427 - [...medical chart for today lists goal to reduce LDL 70,
AQ0428 - per below. ref SDS 0 H25G
AQ0430 - ..
AQ0431 - [On 110802 1539 research Harvard Medical School article
AQ0432 - published Nov 2004, cites studies showing LDL below 70
AQ0433 - reduces risk significantly of adverse coronary events.
AQ0434 - ref SDS 90 E98Y
AQ0436 - ..
AQ0437 - [On 110817 1030 VA end treatment with Simvastatin, which
AQ0438 - reduced LDL by 50% but LDL 102 on lab 110727, ref SDS 89
AQ0439 - E19L, well above LDL < 70 planned by VA, and Simvastatin
AQ0440 - even if increased to 80 mg cannot further lower LDL, and
AQ0441 - Simvastatin 80 mg has adverse side effects of debilitating
AQ0442 - myopathy; so Doctor Egan prescribed rosuvastatin 10 mg to
AQ0443 - replace Simvastatin, which is more potent and so has the
AQ0444 - chance to reach medical goal LDL < 70. ref SDS 91 DG36
AQ0445 -
AQ0446 -
AQ0447 -
AQ0448 -
AQ05 -
SUBJECTS
Aspirin Lower Risk Myocardial Infarction Heart Attack CAD Patient Hi
B603 -
B60401 - ..
B60402 - Aspirin Considered Risk Myocardial Infarction Heart Attack
B60403 -
B60404 - Follow up ref SDS 78 O43I.
B60405 -
B60406 - Doctor Egan asked about patient history taking aspirin, following up
B60407 - discussion during meeting on 110309 0900, ref SDS 78 O43I, and which
B60408 - noted Doctor Sandhu's medical chart for meeting on 101223, saying to
B60409 - consider aspirin to reduce risk of myocardial infarction (heart
B60410 - attack); further citing risks from adverse side effects. ref SDS 70
B60411 - 454F
B60413 - ..
B60414 - Reported today having never taken aspirin except possibly for a
B60415 - headache 10 or 20 years ago.
B60417 - ..
B60418 - The doctor asked about taking aspirin prescribed to recover from CABG
B60419 - surgery on 091022? He seemed familiar with discussion about aspirin 2
B60420 - weeks ago during meeting with Gisela for stress test on 110406 1230.
B60421 - ref SDS 83 YD6F
B60423 - ..
B60424 - Aspirin was taken with other drugs prescribed when discharged from the
B60425 - hospital on 091104 0718. ref SDS 21 414R Weeks later, the
B60426 - cardiothoracic (CT) surgery team advised that medications could end,
B60427 - during a meeting on 091119 1000. ref SDS 23 LC5F Advice to end all
B60428 - drugs aligns with medical chart for meeting on 100305 1000.
B60429 - ref SDS 40 3C5N
B60431 - ..
B60432 - Doctor Egan seemed familiar with published studies some finding
B60433 - potential conflicts between aspirn and low dose Omeprazole 20 mg;
B60434 - other studies report no findings of conflicts, cited in the letter to
B60435 - the medical team on 110329 2213. ref SDS 81 0E4R Concern about
B60436 - conflicts between aspirin and high dose Omeprazole was discussed with
B60437 - Gisela during the stress test on 110406 1230. ref SDS 83 IW5Y
B60439 - ..
B60440 - Reviewed considerations to reduce Omeprazole dose to 40 mg or
B60441 - hopefully to 20 mg per day, as originally prescribed on 100317 1213.
B60442 - ref SDS 41 PU3W Reducing the dose of Omerpazole was discussed with
B60443 - Doctor Lee during the meeting at the VA on 110218 0730. ref SDS 73
B60444 - SR64 After EGD examination, Doctor Lee decided to continue high dose
B60445 - Omeprazole 80 mg, reported on 110218 0730. ref SDS 73 SS8I
B60447 - ..
B60448 - Doctor Egan seemed to indicate that reducing the high dose prescribed
B60449 - for Omerprazole 80 mg per day, could be a favorable factor for adding
B60450 - aspirin to medications.
B60451 -
B60452 - [On 110429 1230 during meeting prior to starting
B60453 - EGD/dilation procedure, Doctor Lee reported having reviewed
B60454 - Doctor Egan's work plan to take aspirin, and Doctor Lee
B60455 - indicated he was unaware of conflict with taking Omeprazole
B60456 - 80 mg per day. ref SDS 86 OG5M
B60458 - ..
B60459 - Today, during the meeting, Doctor Egan did not review health risks of
B60460 - aspirin, cited in the medical chart for the meeting in Primary Care,
B60461 - reported on 101223 1030, ref SDS 70 454F, and reflecting research at
B60462 - that time on adverse side effects of aspirin. ref SDS 70 5D7M
B60463 -
B60464 -
B60465 -
B60466 -
B60467 -
B60468 -
B60469 -
B605 -
SUBJECTS
Schedule Cardiology Meeting August Evaluate Simvastatin 40 MG
BI03 -
BI0401 - ..
BI0402 - Cardiology Schedule Meeting August Evaluate Simvastatin 40 MG
BI0403 -
BI0404 - Doctor Egan proposed follow up examination after blood test planned
BI0405 - for late June in time for meeting with Doctor Sandhu in Primary Care
BI0406 - during July. Doctor Egan will arrange for the VA to submit notice on
BI0407 - schedule for follow up meeting in August with him in the Cardiology
BI0408 - Department to review results of lab for mercury and cholesterol.
BI0409 -
BI0410 - [On 110420 0951 received letter from VA scheduling meeting
BI0411 - on 110810 with Doctor Egan in Cardiology. ref SDS 85 OF8F
BI0413 - ..
BI0414 - [On 110429 1230 Connie in primary care scheduled blood draw
BI0415 - for anytime after 110615; so planning on 110622; and Connie
BI0416 - confirmed the lab will include Mercury, ordered by Doctor
BI0417 - Egan. ref SDS 86 UN8N
BI0419 - ..
BI0420 - [On 110603 1523 scheduled meeting on 110719 0830, with
BI0421 - Doctor Sandhu in Primary Care at VA in Martinez; blood draw
BI0422 - for lab report will be performed a week or so earlier.
BI0423 - ref SDS 88 6I5H; supports Doctor Egan's work plan to assess
BI0424 - cholesterol during meeting at VA on 110807. ref SDS 0 MG3I
BI0425 -
BI0426 -
BI0427 -
BI0428 -
BI0429 -
BI05 -
SUBJECTS
Progress Notes Cardiology VA Medical Chart Meeting
BQ03 -
BQ0401 - ..
BQ0402 - Progress Notes Meeting VA Cardiology Department
BQ0403 -
BQ0404 - Follow up ref SDS 78 S16N.
BQ0405 -
BQ0406 - VA file from CD with Progress Notes for meeting on 110415 are stored
BQ0407 - at...
BQ0409 - ..
BQ0410 - F:\05\00003\SM\CC\AGMJ\20110415-081159\welch-0144.pdf
BQ0412 - ..
BQ0413 - [On 110817 1030 followed up next Progress Notes Cardiology.
BQ0414 - ref SDS 92 S16N
BQ0415 -
BQ0416 - 1. LOCAL TITLE: Cardiology 10501
BQ0417 - STANDARD TITLE: CARDIOLOGY NOTE
BQ0418 - DATE OF NOTE: APR 15, 2011@08:11 ENTRY DATE: APR 15, 2011@08:11:59
BQ0419 - AUTHOR: EGAN,JAMES EXP COSIGNER:
BQ0420 - URGENCY: STATUS: COMPLETED
BQ0421 -
BQ0422 - *** Cardiology 10501 Has ADDENDA ***
BQ0427 - ..
BQ0428 - 66 year old MALE followed in Cardiology Clinic for problems
BQ0429 - including
BQ0430 -
BQ0431 - 1. CAD
BQ0432 -
BQ0433 - a) Angina, class II- III 10/2/09
BQ0435 - ..
BQ0436 - b) Abnormal TMST, relatively low work load 9/16/09
BQ0438 - ..
BQ0439 - c) CABGx4v 10/22/09 SFVA (LIMA-->LAD, SVG-->diag,
BQ0440 - SVG-->Ramus,SVG-->PDA).
BQ0442 - ..
BQ0443 - 2. Hyperlipidemia
BQ0445 - ..
BQ0446 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
BQ0447 - the San Francisco VA December 2009. Subsequently recurrent
BQ0448 - stricture most recently noted at EGD 2/18/11.
BQ0450 - ..
BQ0451 - 4. PACs with exercise on ETT 4/6/11
BQ0453 - ..
BQ0454 - 2. The patient was last seen in clinic on 3/9/11 , A&P as follow:
BQ0456 - ..
BQ0457 - This part of Progress Notes repeats from prior notes on 110309...
BQ0458 -
BQ0459 - 1. ASSESSMENT:
BQ0460 -
BQ0461 - 1) CAD , stable, asymptomatic.
BQ0462 -
BQ0463 - 2) Hyperlipidemia, most recent lab does not demonstrate
BQ0464 - adequate control, should target LDL< 70 mg dl as
BQ0465 - primary goal
BQ0467 - ..
BQ0468 - 3) Palpitations in November uncertain etiology.
BQ0470 - ..
BQ0471 - 2. PLAN:
BQ0472 -
BQ0473 - 1) Current medications reconciled.
BQ0474 -
BQ0475 - 2) Discussed pros and cons of chronic asa, strongly
BQ0476 - indicated permanently from my point of view unless
BQ0477 - complicateions such as GI upset or bleed. He agrees to
BQ0478 - reinitiate 81 mg daily
BQ0480 - ..
BQ0481 - 3) Advise that we should increase simvastatin to 80 mg,
BQ0482 - prefers to continue with weight loss and exercise to
BQ0483 - see if he can bring LDL to target.
BQ0485 - ..
BQ0486 - 4) Holter, r/o silent atrial fibrillation.
BQ0488 - ..
BQ0489 - 5) ETT as new baseline.
BQ0491 - ..
BQ0492 - 6) Will RTC shortly after HM and ETT.
BQ0493 -
BQ0494 - 3. /es/ James Egan, MD
BQ0495 - Staff Physician, Cardiology
BQ0496 - Signed: 03/09/2011 09:51
BQ0498 - ..
BQ0499 - Remainder of Progress Notes pertain to meeting today on 110415...
BQ0500 -
BQ0501 - 3. Currently doing very well. Hiking long distances without
BQ0502 - limitation by dyspnea or angina. Still not taking asa, asked
BQ0503 - him to discuss this with Dr Lee. Will be doing lipids for Dr
BQ0504 - Sandhu in June.
BQ0506 - ..
BQ0507 - 4. No history of dizziness, lightheadedness or syncope. No focal
BQ0508 - neurologic symptoms
BQ0510 - ..
BQ0511 - 5. No palpitations.
BQ0513 - ..
BQ0514 - 6. No history suggestive of angina pectoris.
BQ0516 - ..
BQ0517 - 7. Denies DOE, PND, Orthopnea, Edema
BQ0519 - ..
BQ0520 - 8. PAST MEDICAL HISTORY:
BQ0521 -
BQ0522 - 1. Computerized Problem List is the source for the following:
BQ0523 -
BQ0524 - 1. Postsurgical Aortocoronary Bypass Status (ICD-9-CM
BQ0525 - V45.81) 03/09/11 Egan, James
BQ0527 - ..
BQ0528 - 2. Esophageal Stricture 03/05/10 LEE,RANDALL E
BQ0530 - ..
BQ0531 - 3. Screening for Malignant Neoplasms of colon 11/15/11
BQ0532 - LEE,RANDALL E (ICD-9-CM V76.51)
BQ0533 -
BQ0534 - 2010 colonoscopy: no polyp. Next screen 2020
BQ0536 - ..
BQ0537 - 4. Coronary Atherosclerosis (unspecified type 02/02/10
BQ0538 - LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
BQ0540 - ..
BQ0541 - 5. Coronary Artery Bypass using Venous and 01/04/10
BQ0542 - SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
BQ0543 - Onset 10/00/09 done at vasf
BQ0545 - ..
BQ0546 - CABG was performed at VA San Francisco Medical Center on 091022.
BQ0547 - ref SDS 3 PQWU
BQ0549 - ..
BQ0550 - Onset reported to VA on 090908 1130. ref SDS 2 MY4N
BQ0552 - ..
BQ0553 - VA Progress Notes Cardiology meeting 110415 continue...
BQ0554 -
BQ0555 - 6. Surgical Thoracoscopy with Esophagomyotomy 01/04/10
BQ0556 - SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
BQ0558 - ..
BQ0559 - 7. Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
BQ0561 - ..
BQ0562 - 8. Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
BQ0563 - 03/12/07 LIN,BERTHA
BQ0565 - ..
BQ0566 - 9. Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
BQ0568 - ..
BQ0569 - 10. Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
BQ0571 - ..
BQ0572 - 11. Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
BQ0574 - ..
BQ0575 - 12. Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
BQ0577 - ..
BQ0578 - 13. Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
BQ0579 - MARGULIES,LINDA
BQ0581 - ..
BQ0582 - 14. Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
BQ0584 - ..
BQ0585 - 15. Blepharitis NOS 02/21/07 MARGULIES,LINDA
BQ0587 - ..
BQ0588 - 16. Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
BQ0590 - ..
BQ0591 - 17. Abn. LFT's 08/16/05 SANDHU,HARKESH
BQ0593 - ..
BQ0594 - 18. Obesity 06/29/05 SANDHU,HARKESH
BQ0596 - ..
BQ0597 - 19. Rosacea 06/29/05 SANDHU,HARKESH
BQ0599 - ..
BQ0600 - 20. Tinea Unguium 06/29/05 SANDHU,HARKESH
BQ0602 - ..
BQ0603 - 2. Patient has answered NKA (no known allergies)
BQ0605 - ..
BQ0606 - 9. Active Outpatient Medications (including Supplies):
BQ0607 -
BQ0608 - 1. OMEPRAZOLE 20MG EC CAP TAKE TWO CAPSULES BY MOUTH TWICE A
BQ0609 - ACTIVE DAY 15 MINUTES BEFORE A MEAL FOR SEVERE ACID REFLUX
BQ0610 - AND ESOPHAGEAL NARROWING. **DOSE INCREASE**
BQ0612 - ..
BQ0613 - 2. SIMVASTATIN 80MG TAB TAKE ONE-HALF TABLET BY MOUTH EVERY
BQ0614 - ACTIVE EVENING - FOR CHOLESTEROL*USE PILL CUTTER* DO NOT
BQ0615 - TAKE WITH GRAPEFRUIT JUICE.
BQ0617 - ..
BQ0618 - 10. PHYSICAL EXAM - Date: 110309 0903
BQ0619 -
BQ0620 - T.......................
BQ0621 - P....................... 60
BQ0622 - R.......................
BQ0623 - B/P..................... 123/70
BQ0624 - Wt...................... 200.00 (90.9 KG) (ACTUAL STANDING WEIGHT)
BQ0625 - Body Mass Index.........
BQ0626 - Pulse Oximetry..........
BQ0627 - Pain....................
BQ0629 - ..
BQ0630 - 11. Head atraumatic, PERRL.
BQ0631 - Carotid upstrokes normal, no bruits noted
BQ0632 - Thyroid normal to palpation.
BQ0633 - JVP wnl.
BQ0634 - Cor:
BQ0635 - Lungs clear of rales, ronchi and wheezes.
BQ0636 - Extremities without cyanosis, clubing or edema.
BQ0638 - ..
BQ0639 - 12. Collection DT Spec CHOL TRIGLYC HDL LDL-CHO
BQ0640 - 12/07/2010 09:17 PLASM 151 41 47 96
BQ0641 - 07/21/2010 08:54 PLASM 261 H 87 35 L 209 H
BQ0643 - ..
BQ0644 - Collection DT Spec GLUCOSE BUN CREAT NA K CL CO2
BQ0645 - 12/07/2010 09:17 PLASMA 102 8 0.85 137 3.8 104 28
BQ0646 - 07/21/2010 08:54 PLASMA 117 12 0.89 139 3.9 106 28
BQ0648 - ..
BQ0649 - Collection DT Spec WBC HGB HCT MCV MCHC PLT
BQ0650 - 12/07/2010 09:17 BLOOD 6.7 14.4 43.3 90.7 33.1 310
BQ0651 - 07/21/2010 08:54 BLOOD 7.3 14.9 44.0 91.2 33.8 344
BQ0653 - ..
BQ0654 - These valuations align with VA lab on 101207 0906. ref SDS 63 E19L
BQ0656 - ..
BQ0657 - VA Progress Notes Cardiology meeting 110415 continue...
BQ0659 - ..
BQ0660 - 13. EKG Date: 11/17/09 @ 1558
BQ0661 - Vent Rate: 62 PR Interval: 166
BQ0662 - QRS Duration: 82 QT: 430
BQ0663 - QTC: 436 P Axis: 42
BQ0664 - R Axis: 8 T Axis: 75
BQ0665 - Confirmation Status: Interpreted By: URSELL,SHANTHA N
BQ0667 - ..
BQ0668 - 14. Auto Instrument Diagnosis:
BQ0669 -
BQ0670 - Normal sinus rhythm
BQ0671 - Nonspecific T wave abnormality
BQ0672 - Abnormal ECG
BQ0673 - When compared with ECG of 02-NOV-2009 07:43,
BQ0674 - Nonspecific T wave abnormality no longer evident in Inferior leads
BQ0675 - T wave inversion no longer evident in Anterior leads
BQ0676 - Confirmed by URSELL MD, SHANTHA (703) on 11/18/2009 11:51:16 AM
BQ0678 - ..
BQ0679 - Auto Instrument Data?:
BQ0680 - Primary Provider: URSELL,SHANTHA N
BQ0682 - ..
BQ0683 - 15. ETT 4/6/11
BQ0684 -
BQ0685 - COMMENTS:
BQ0686 -
BQ0687 - 1. The patient exercised according to BRUCE for 10:00, achieving a
BQ0688 - work level of Max.METS: 11.70.
BQ0690 - ..
BQ0691 - 2. Resting heart rate initially 71 bpm, rose to a maximum heart
BQ0692 - rate of 160 bpm which represents 103% of the maximal
BQ0693 - age-predicted heart rate.
BQ0695 - ..
BQ0696 - 3. Resting blood pressure 120/86 mmHg, rose to a maximum blood
BQ0697 - pressure of 160/82 mmHg.
BQ0699 - ..
BQ0700 - 4. The exercise test was stopped due to EKG CHANGES. Completed 10
BQ0701 - minutes Bruce Protocol. Normal heart rate, blood pressure
BQ0702 - response.
BQ0704 - ..
BQ0705 - 5. Frequent PAC's noted at peak exercise.
BQ0707 - ..
BQ0708 - 6. No ST-T changes noted with exercise.
BQ0710 - ..
BQ0711 - 7. Myoview study pending.
BQ0713 - ..
BQ0714 - 8. Abnormal, exercise induced atrial arrhythmia.
BQ0715 -
BQ0716 -
BQ0717 - [On 110817 1030 follow up, ref SDS 91 QP4F
BQ0718 -
BQ0719 - [On 110817 1030 no "Myview" study was performed, so no
BQ0720 - report is pending. ref SDS 91 PM6N
BQ0722 - ..
BQ0723 - 16. Holter 3/10/11
BQ0725 - ..
BQ0726 - Reference to "Holter test 3/10/11," relates to test performed on
BQ0727 - 110310 0930. ref SDS 79 OF8F, with results submitted the next day on
BQ0728 - 110311 0930. ref SDS 80 OF8F
BQ0730 - ..
BQ0731 - Pg. 1 04/12/11 14:52
BQ0733 - ..
BQ0734 - CONFIDENTIAL HOLTER REPORT - RELEASED OFF-LINE VERIFIED
BQ0736 - NOT INPATIENT DOB: MAR 1,1945
BQ0737 - PROCEDURE DATE/TIME: 03/10/11 09:49
BQ0739 - ..
BQ0740 - WARD/CLINIC:
BQ0742 - ..
BQ0743 - REQUESTED BY: EGAN,JAMES
BQ0745 - ..
BQ0746 - 17. REASON FOR STUDY: PALPITATIONS [...reported meeting on 110309
BQ0747 - 0900. ref SDS 78 MY9V...]
BQ0749 - ..
BQ0750 - REVIEWED BY: EGAN,JAMES
BQ0752 - ..
BQ0753 - TAPE QUALITY: GOOD HOURS: 23 TOTAL, 23 READABLE
BQ0755 - ..
BQ0756 - MALFUNCTIONS:
BQ0758 - ..
BQ0759 - 18. ----------------------------RESULTS ---------------------------
BQ0760 - HEART RATE TIME
BQ0761 - AVERAGE................................. 69
BQ0762 - MAXIMUM................................. 152 11:23AM
BQ0763 - MINIMUM................................. 42 5:20AM
BQ0765 - ..
BQ0766 - 19. VENTRICULAR ATRIAL
BQ0767 - ----------------------------------------------------------
BQ0768 - 90710 TOTAL BEATS 472 TOTAL BEATS
BQ0769 - 94 TOTAL VPBS, 0.1 % OF BTS TOTAL ECTOPICS, % OF BTS
BQ0770 - 4 AVE/HOUR AVE/HOUR
BQ0771 - 152 MAX/HOUR MAX/HOUR
BQ0772 - 94 ISOLATED 288 ISOLATED
BQ0773 - 0 BIGEMINY BLOCKED APCS
BQ0774 - 0 COUPLETS COUPLETS
BQ0775 - BEATS IN RUNS 0 RUNS SV-T
BQ0776 - BEATS IN LONGEST RUN BEATS IN RUNS
BQ0777 - BEATS FASTEST RUN AT BPM BEATS IN LONGEST RUN
BQ0778 - BTS FASTEST RUN AT BPM
BQ0779 - ..
BQ0780 - ST LEVEL: MM
BQ0782 - ..
BQ0783 - 20. ------------------------------SUMMARY ------------------------------
BQ0784 - HEART BLOCK:
BQ0785 - PAUSES SINUS:
BQ0786 - PAUSES VENTRICULAR:
BQ0787 - HEART MEDS:
BQ0789 - ..
BQ0790 - 21. INTERPRETATION:
BQ0791 -
BQ0792 - 1. The predominant rhythm mechanism is sinus, range
BQ0793 - 42-152, average 69, maximum R-R=1.84 seconds.
BQ0794 -
BQ0795 - 2. Beats in tachycardia 10%, bradycardia 30%.
BQ0797 - ..
BQ0798 - 3. Isolated PVC's, no couplets or runs.
BQ0800 - ..
BQ0801 - 4. PAC's with couplets, no runs.
BQ0803 - ..
BQ0804 - 22. ASSESSMENT:
BQ0805 -
BQ0806 - 1. CAD,S/P CABG, asymptomatic . Significant improvement in
BQ0807 - TM performance post- CABG
BQ0809 - ..
BQ0810 - 2. Hyperlipidemia, target LDL < 70 mg/dl.
BQ0812 - ..
BQ0813 - Medical chart aligns with discussion during the meeting today, shown
BQ0814 - above. ref SDS 84 MG3I
BQ0815 -
BQ0816 - [On 110802 1539 research Harvard Medical School article
BQ0817 - published Nov 2004, cites studies showing LDL below 70
BQ0818 - reduces risk significantly of adverse coronary events.
BQ0819 - ref SDS 90 E98Y
BQ0821 - ..
BQ0822 - [On 110817 1030 VA end treatment with Simvastatin, which
BQ0823 - reduced LDL by 50% but LDL 102 on lab 110727, ref SDS 89
BQ0824 - E19L, well above LDL < 70 planned by VA, and Simvastatin
BQ0825 - even if increased to 80 mg cannot further lower LDL, and
BQ0826 - Simvastatin 80 mg has adverse side effects of debilitating
BQ0827 - myopathy; so Doctor Egan prescribed rosuvastatin 10 mg to
BQ0828 - replace Simvastatin, which is more potent and so has the
BQ0829 - chance to reach medical goal LDL < 70. ref SDS 91 DG36
BQ0831 - ..
BQ0832 - VA Progress Notes Cardiology meeting 110415 continue...
BQ0833 -
BQ0834 - 3. PACs with exercise on ETT 4/6/11, no treatment mandated.
BQ0836 - ..
BQ0837 - 23. PLAN:
BQ0838 -
BQ0839 - 1. Current medications reconciled, no changes made.
BQ0840 -
BQ0841 - 2. To discuss asa use with Dr Lee.
BQ0842 -
BQ0843 - [...below on 110415 0900 addendum reports Doctor Lee's
BQ0844 - comments that aspirin prescription for cardiology does not
BQ0845 - conflict with Omeprazole prescription to treat achalasia.
BQ0846 - ref SDS 0 OK3G
BQ0848 - ..
BQ0849 - 3. F/U Dr Sandhu with lipids 1-2 months
BQ0851 - ..
BQ0852 - 4. RTC 4 months.
BQ0854 - ..
BQ0855 - 24. Clinical Reminders:
BQ0856 -
BQ0857 - 1. Consider Aspirin for risk of MI:
BQ0858 - 2. Aspirin not used or prescribed for this patient:
BQ0859 - 3. Reason -Patient declines despite risk
BQ0861 - ..
BQ0862 - 25. /es/ James Egan, MD
BQ0863 - Staff Physician, Cardiology
BQ0864 - Signed: 04/15/2011 09:39
BQ0865 -
BQ0867 - ..
BQ0868 - Addendum Local Title 110429 Comment Cardiology Local Title 110429
BQ0869 -
BQ0870 -
BQ0871 - 1. 04/29/2011 ADDENDUM STATUS: COMPLETED
BQ0872 - Discussed use of ASA with patient.
BQ0873 -
BQ0874 - 1. I believe he was mistaking the reports of adverse
BQ0875 - interaction between omeprazole and clopidogrel.
BQ0877 - ..
BQ0878 - 2. I have no objection to ASA use for cardioprotection in this
BQ0879 - patient, and I suggested that he start 81mg/day.
BQ0881 - ..
BQ0882 - "ASA" is a medical shorthand for aspirin.
BQ0884 - ..
BQ0885 - Doctor Lee seems to comment on Plan in Local Title dated 110415, per
BQ0886 - above. ref SDS 0 F55H
BQ0888 - ..
BQ0889 - 3. /es/ RANDALL E LEE, MD
BQ0890 - STAFF PHYSICIAN, GASTROENTEROLOGY
BQ0891 - Signed: 04/29/2011 17:09
BQ0892 -
BQ0894 - ..
BQ0895 - 2. Receipt Acknowledged By:
BQ0896 - 05/02/2011 07:57 /es/ Gisela Brunskill, NP
BQ0897 -
BQ0898 -
BQ0899 -
BQ0900 -
BQ0901 -
BQ0902 -
BQ0903 -
BQ0904 -
BQ0905 -
BQ0906 -
BQ0907 -
BQ0908 -
BQ0909 -
BQ0910 -