Name: Teopiz, Mark Jovan Jr.

Date: December 7, 2021

Subject: NURSING INFORMATICS
Activity #: 1

CARDIOLOGY CONSULTATION

Diagnosis:

A diagnosis is one mitral valve disease, status post mitral valve replacement with
a St. Jude’s prosthetic valve and coronary artery bypass times one hospital. A
history of two previous repair vascular accident secondary to blood disorder from
inadequate
Anticoagulation, 3 atrial fibrillations, on coumadin with iron or 3.1 or what
possible tia.

Subjective:

On, yesterday, with right arm weakness and numbness this patient returns to
Cardiology clinic in this not feel well today. He thinks that he had a (transient
Ischemic attack) tia yesterday in which he had sudden right on weakness.

Objective:

His EKG shows atrial fibrillation with a controlled ventricular response, and t-
Wave inversions consistent with ischemia.

Physical examination today bp is 149 / 69 left 167 / 72 right pulse 89 in the

regular

Way to 180 pounds, chest is clear. Cardio examination reveals good prosthetic
clips

Of the mitral valve prosthesis. There is a low-pitched rumble in diastole which is

Appropriate. There is no mitral regurgitation clinically. There is no edema.

Comments/recommendations:

Comments and recommendations as patient know with mitral valve replacement and
Atrial fibrillation INR should be 3.5 to 4.5 especially in the setting of previous
Embolic episodes. EKG suggesting ischemia is a concern and patient should probably
Have a thallium imaging study.

Plan:

My plan will be to stop sotalol since patient has been chronically in atrial
Fibrillation, we placed him on the top-level xl 25mg today for hypertensive
control
Which may be increased. I am going to give the patient a copy of this ekg and
Suggested that very strongly that he see his primary his local private
cardiologist
To continue it, for consideration of tallying imaging, possible transesophageal
echo
To assess mitral valve, possible dc cardioversion. I will plan a cardiology follow
Up in our clinic in my next available slot probably six to nine months to review
The patient. I am not going to order a repeat echo.