Hi this is one of my tools out to seize commerce status post Michael valve replacement with a

Saint Jude's prosthetic out. Current every RT by PS times 110 hospital. To a history of 2

previous Ripper vascular accident secondary to abolish disorder from and from inadequate
anticoagulation 3 atrial fibrillation, on coumadin with Iran are 3.one. 4 possible TI 8 on,
yesterday, with right arm weakness and numbness. If you put this patient returns to cardiology
clinic of the staff feel well today period he thinks that he had a C. I. A. S. today in which he has
had 7 right arm weakness period his EKG today shows atrial fibrillation with a controlled centric
in response,. And he wave inversions consistent with ischemia period this sounds like the same
appearing EKG that has previously been done in January, however I do not have the EKG for
comparison. Patient is on sotalol and it would be reasonable to stop this medication period
patient occasionally has engine about twice a month we lead by nitroglycerin period patients
followed by truck but. Patient had a cardiac echo done. And in this study less intricate the
function was seen to be normal a prosthetic mitral valve the tipping this variety was working
well. And there was a question. Of. An atrial septal defect however there this was that it will
documented a pair of properly and the bachelor valve appear to function well and patient was in
atrial fibrillation at that time.. The physical examination today PP is 149 of the 69 left 167 of the
72 right posts 89 in the regular weight 180 pounds chest was clear cut examination reveals
good press that it clicks of the mice without prosthesis there is a low pitched rumble in diastole
which is appropriate period there is no my 2 regurgitation clinically period there was nobody in
the period comments and recommendations as patient knows with mitral valve replacement and
atrial fibrillation Y. and R. should be. 3.5 to 4.5 the specially in the setting of previous symbolic
episodes.. He Katie suggestive suggesting ischemia is of concern and patients should probably
have a Celine imaging study period impact with my plan will be to stop the subtle since patient
has been chronically in H. 2 Feb elections, we place among the Topol excel 25 MG today for
hypertensive control which may be increased period I am going to give the paste and copy this
EKG and suggests that them very strongly that he sees his primary has a local private
cardiologists talked with. We'll continue it for consideration of Talion imaging, possibly trans
assassins you echo to assess much without comment possible PC Cordy version period I will
plan a cardiology follow up in a clinic in my next available spot probably 6 to 9 months to review
the patient period I'm not going to order a repeat echo period and.