Name:

Date:
Subject:NUR 115
Activity #: 1

CARDIOLOGY CONSULTATION

Diagnosis:

one mitral valve disease, Status post mitral valve replacement with saith jude
prosthetic valve. currently artery bypass times 1 then hospital
2. history of two previous repo vascular accidents , secondary to a ballot, this
order form inadequate anticoagulation, 3 artial fibrallation. come on caumadin
with INR 3.14 . Patient is on cotalol

Subjective:

patient thinks that he had ATI yesterday

Objective:
right aerm weakness. EKG shows atrial fibrillation with control ventricular
response, T wave inversion consistent with ischemia period. same with the sound
appearing EKG that is done in january, angina twice a month, and leave if with
nitroglycerin . patient is followed by doctor patient had acardiac echo done. om
this study left vantricilar function was seen to be normal prosthetic mitral valve
of the tilting . this variety was working well. and there was a question pf am
atria; septa; defect. however, their this was not as well documented. apair of
appropriately and the mitral valve appears to function well and patient was in
atrial fibrilation at that time.
Physical examination today
BP is 149/ 69 left, 167/70 to right. pulse 89, regular weight 280 pounds , chest
is clear, party examination revealed. good prosthetic clicks of the mitral valve
prosthesis. there was a low pitched rumble in the diastole which is appropriate.
there is no mitral regurgitation clinically. there wa sno edema.

Comments/Recommendations:

patient with mitral valve replacement and atrial fibrillation.INR should be #>5 to
4.5 especially in the setting of previous embolic period episodes . ekg suggestion
is suggesting ischemia is of concern and patient , should probably have an imagin
study period
Plan:

Stop sodalol since patient has been clinically in atrial fibrillation ,place them
on metoprolol XL. 25 mg today. for hypertensive control. give patient copies of
EKG. and suggest to see a local private cardiologist Dr. for continuous
consideration of calium imaging, possibly transesophagealecho echo to assess
mitral valve. to assess mitral valve possible TC cardioversion cardiology
follow-up in our clinic in my next avai;ab;e slot , probable six to nince months
to review the patient period