Ticket Id: 167634

Emergency Cardiologist
Emergency Department
Hampshire Hospital
Andover

23. 05. 2023

Dear Doctor,
Re: Mr. William Avila, a 69-year-old retired politician

Thank you for accepting Mr Avila, who is showing signs of acute heart failure and possible silent
myocardial ischaemia, for urgent assessment and management.

On 12. 02. 2020, Mr Avila presented with complaints of worsening dyspnea, decreased stamina and 4
months of ankle oedema. He had orthopnea since last week. On examination, his BP was elevated to Comment [OET1]: also reported a ne-
158/93 mmhg and temperature was 37. 2C. His chest examination showed apex shifted laterally with week history of orthopnea
ejection pansystolic murmur. In addition, bibasal crepitations were also present. Bilateral oedema was
confirmed, reaching the ankle. T inversion of antero- lateral leads was presented in the ECG without Q
wave and ST elevation which changed from 6 months ago. Comment [OET2]: showing changes from
the ne done
Mr Avila suffers from poorly controlled DM, Mild- moderate hypertension and ischemic heart disease. His Comment [OET3]: as has
past medical history includes coronary artery angioplasty after an acute MI in 2014 and he underwent a Comment [OET4]: m
cataract surgery in 2016. His regular medications include Novorapid and Lantus injections along with
Metformin 500 mg, Valsartan 20 mg, Sacubitril 24 mg, Aspirin 3 g, Rosuvastatin 10 mg, Nifedipine 30 and Comment [OET5]: m
hydrochlorothiazide 50 mg. Comment [OET6]: v
Comment [OET7]: s
My provisional diagnosis is biventricular heart failure with reduced ejection fraction. He could also
Comment [OET8]: a
possibly be suffering from silent ischaemia due to his HTN and uncontrolled DM.
Comment [OET9]: r

I appreciate your immediate assessment and management would be appreciated. Comment [OET10]: n
Comment [OET11]: with the possibility f
silent ischaemia
Should you require any further information, please do not hesitate to contact me.
Comment [OET12]: In view f the above,
Yours faithfully,
Doctor

Report
Word Length 211
Comments The purpose is clear. However, a couple of parts can be developed
in a better way. Other inaccuracies pertain to capitalization, word
choice and grammar. Overall, the letter needs improvements.

Estimated Grade C+
Estimated Score 340/500
Advice 1. Avoid basic grammar errors.
2. Punctuate the content appropriately.
3. Pay attention to spelling and capitalization.
4. Improve choice of words.
5. Always proofread the letter after finishing it.

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