CONTACTS
SUBJECTS
Afib Diagnose Coronary Heart Disease Schedule 110310 24 Hour Heart M
6603 -
6603 - ..
6604 - Summary/Objective
6605 -
660501 - Follow up ref SDS 75 0000. ref SDS 71 0000.
660502 -
660503 -
660504 -
660506 - ..
6606 -
6607 -
6608 - Progress
6609 -
660901 - Stress Test Ordered Evaluate Recovery Heart Surgery 091022
660902 - LDL < 70 New Standard of Care Heart Surgery CAD Patients
660903 -
660904 - Follow up ref SDS 75 OF8F.
660905 -
660906 - Visited Doctor Egan in Cardiology Department, scheduled last week on
660907 - 110304 1126. ref SDS 75 OF8F
660909 - ..
660910 - 1. Schedule stress test evaluate recovery heart surgery on 091022,
660911 - compare with prior treadmill stress test on 090916, and
660912 - discussed with Doctor Egan reported on 091002 0900. ref SDS 11
660913 - 789N
660915 - ..
660916 - Doctor Egan pleased cholesterol fell dramatically. LDL 96 dropped
660917 - more that 50% from 209, for lab on 101207 0906. ref SDS 61 E19L The
660918 - doctor wants LDL 96 to fall below 70 for considering treatment with
660919 - Simvastatin pills can stop. This extends Doctor Sandhu's work plan
660920 - for lowering LDL below 90, reported on 101223 1030. ref SDS 68 XY9F
660921 - VA assessment in medical chart at that time on 101223 says LDL 96 is
660922 - already "at goal."
660923 -
660924 - [On 110415 0900 Doctor Egan discusses increasing
660925 - Simvastatnin 40 mg dose to 80 mg in order to lower LDL
660926 - below 70. ref SDS 77 EH5H, and notes in medical chart
660927 - should target LDL < 70 for primary goal. ref SDS 77 E637
660929 - ..
660930 - [On 110817 1030 VA end treatment with Simvastatin, which
660931 - reduced LDL by 50% but LDL 102 on lab 110727, ref SDS 82
660932 - E19L, well above LDL < 70 planned by VA, and Simvastatin
660933 - even if increased to 80 mg cannot further lower LDL, and
660934 - Simvastatin 80 mg has adverse side effects of debilitating
660935 - myopathy; so Doctor Egan prescribed rosuvastatin 10 mg to
660936 - replace Simvastatin, which is more potent and so has the
660937 - chance to reach medical goal LDL < 70. ref SDS 83 DG36
660939 - ..
660940 - Doctor Egan ordered stress test. VA will notify date for test likely
660941 - in a few next weeks.
660942 -
660943 - [On 110406 1230 treadmill stress test performed; initial
660944 - indications are 100% performance, with one node showing
660945 - possible slight irregularity. ref SDS 76 OF8F
660947 - ..
660948 - [On 110520 1537 medical chart indicates results of stress
660949 - test on 110406 not compared to test on 090916; compared to
660950 - test on 091102. ref SDS 81 M46G
660952 - ..
660953 - The doctor explained that a new stress test will set a baseline for
660954 - evaluating future problems, since the test on 090916, and reported in
660955 - the medical chart for 091002, ref SDS 11 1W5I, was symptomatic,
660956 - leading to heart surgery on 101022.
660957 -
660958 - [On 110520 1537 medical chart resports stress test on
660959 - 110406 was asymptomatic for CAD, showing significant
660960 - improvement. ref SDS 81 PY4K
660962 - ..
660963 - 2. Afib events reported to medical team on 101117 0530,
660964 - ref SDS 57 OS6H, and citing letters on...
660965 -
660966 - a. Notified medical team on 101105 2223. ref SDS 51 755I
660967 -
660968 - b. Request comment on continuing issue on 101110 1216.
660969 - ref SDS 53 W54S
660971 - ..
660972 - c. Doctor Zimmet commended Doctor Egan's work, and recommended
660973 - cardiology test to evaluate possible afib events, and
660974 - assess requirements for treatment, reported on 101117 0530.
660975 - ref SDS 57 SV43
660977 - ..
660978 - 3. Slight dizziness faint headed after exercise.
660980 - ..
660981 - The doctor asked about patient hiking, discussed at the prior meeting
660982 - on 091002 0900, ref SDS 11 LF6O, and cited in the doctor's medical
660983 - chart progress notes. ref SDS 11 0L9J
660985 - ..
660986 - Patient history shows rising exercise since heart surgery on 091022,
660987 - reported in case study on 101010 0744. ref SDS 48 QJ5I Was sick for a
660988 - month or so in December, and inclement weather curtailed exercise,
660989 - including sore shoulders that prevented pushups on 101224, also in
660990 - case study on 101010. ref SDS 48 554N
660992 - ..
660993 - Doctor Egan ordered heart monitoring test to evaluate afib. This will
660994 - occur beginning tomorrow at 0930. Patient will be fitted with a heart
660995 - monitor and probes spread across the chest. This will be worn for 24
660996 - hours to collect continuous data.
660998 - ..
660999 - Will meet with Doctor Egan after data has been analyzed, about a week
661000 - after the test. Will coordinate actual meeting to occur after stress
661001 - test in a few weeks, so only 1 meeting is needed.
661002 -
661003 - [On 110415 0900 Doctor Egan reported favorable test results
661004 - indicate good cardiology health, ref SDS 77 OF8F, and
661005 - planned follow up examination, ref SDS 77 9W3N
661007 - ..
661008 - [On 110420 0951 received letter from VA scheduling meeting
661009 - on 110810 with Doctor Egan in Cardiology. ref SDS 79 OF8F
661011 - ..
661012 - [On 110429 1230 Connie in primary care scheduled blood draw
661013 - for anytime after 110615; so planning on 110622; and Connie
661014 - confirmed the lab will include Mercury, ordered by Doctor
661015 - Egan. ref SDS 80 UN8N
661016 -
661017 -
661018 -
6611 -
SUBJECTS
Default Null Subject Account for Blank Record
6703 -
670401 - ..
670402 - Myocardial Infarction Heart Disease Risks Reduced Aspirin
670403 - Aspirin Avoid Heart Attack Side Effects Ulcers Bleeding
670404 - Aspirin Recommended Avoid High Blood Pressure Conflict Omeprazole??
670405 -
670406 - Follow up ref SDS 68 454F.
670407 -
670408 - Doctor Egan recommends taking an aspirin every day to avoid high blood
670409 - pressure causing blood clots, stroke, and death. Aspirin is a blood
670410 - thinner, weaker than warfarin, which Millie took for about 6 years to
670411 - treat pulmonary embolism, reported on 041104 1030. ref SDS 1 1U5K
670413 - ..
670414 - Aspirin is recommended in the medical chart for meeting with Doctor
670415 - Sandhu in Primary Care on 101223. Though not discussed during the
670416 - meeing, the medical chart says risks taking aspirin were presented on
670417 - 101223. ref SDS 68 454F
670418 -
670420 - ..
670421 - Side effects of aspirin include...
670422 -
670423 - ulcers........................... 101223, ref SDS 68 W66I
670424 - bleeding......................... 101223, ref SDS 68 W66I
670425 - nausea........................... 101223, ref SDS 68 WG4I
670426 - hearing loss..................... 101223, ref SDS 68 WG4I
670427 - breathing problems............... 101223, ref SDS 68 WG4I
670428 - stroke........................... 101223, ref SDS 68 Q19F
670429 - death............................ 101223, ref SDS 68 Q19F
670431 - ..
670432 - Conflicts between aspirin and high dose Omperazole needs to be
670433 - reviewed.
670434 -
670435 -
670436 -
670437 -
670438 -
6705 -
SUBJECTS
Progress Notes Cardiology VA Medical Chart Meeting
7203 -
720401 - ..
720402 - Progress Notes Meeting VA Cardiology Department
720403 -
720404 - Follow up ref SDS 68 188K, ref SDS 11 0L9J.
720405 -
720406 - Prior Progress Notes with Doctor Egan was for meeting on 091002 0900.
720407 - ref SDS 11 0L9J At that time, he prescribed angiogram test for triple
720408 - vessel stinosis. ref SDS 11 7S8M
720410 - ..
720411 - After CABG x4 surgery on 091022, ref SDS 13 PQWU, was released from
720412 - hospital on 091104. ref SDS 20 PR4V About 6 weeks later had Heller
720413 - Myotomy surgery to resolve achalasia, reported on 091216. ref SDS 28
720414 - KE9U
720416 - ..
720417 - Post CABG review was done at VA Medical Center in San Francisco on
720418 - 091119 1000. ref SDS 22 NO6N
720420 - ..
720421 - During the meeting on 091119, Neil discussed ending treatment with
720422 - post-surgery drugs, ref SDS 22 LC5F, prescribed in the Medical Chart
720423 - received from Paula on 091104 with discharge instructions on
720424 - medications. ref SDS 20 1Q6P Erick recalled that Amiodarone normally
720425 - ends 30 days from date of surgery. Since surgery was on 091022,
720426 - ref SDS 13 PQWU, Neil approved ending Amiodarone on 091122. The other
720427 - drugs end when pills run out. ref SDS 22 LC5F
720429 - ..
720430 - On 091219 0600 met with CT surgery team in TCU unit of VA Medical
720431 - Center in San Francisco while recovering Heller Myotomy surgery,
720432 - ref SDS 31 0M6S; examination showed good progress recovering from
720433 - heart surgery (CAGB) 2 months earlier on 091022, and so no further
720434 - follow up is required. ref SDS 31 2R4O
720436 - ..
720437 - On 100105, met with Doctor Sandhu in Primary Care, and he prescribed
720438 - taking Simvastatin 20 mg. ref SDS 38 FG6K
720440 - ..
720441 - VA file from CD with Progress Notes for meeting on 110309 are stored
720442 - at...
720444 - ..
720445 - F:\05\00003\SM\CC\AGMJ\20110309-083347\welch-0144.pdf
720447 - ..
720448 - [On 110415 0900 followed up next Progress Notes Cardiology.
720449 - ref SDS 78 S16N
720450 -
720451 - 1. LOCAL TITLE: Cardiology 10501
720452 - STANDARD TITLE: CARDIOLOGY NOTE
720453 - DATE OF NOTE: MAR 09, 2011@08:33 ENTRY DATE: MAR 09, 2011@08:33:47
720454 - AUTHOR: EGAN,JAMES EXP COSIGNER:
720455 - URGENCY: STATUS: COMPLETED
720460 - ..
720461 - 66 year old MALE followed in Cardiology Clinic for problems
720462 - including
720463 -
720464 - 1. CAD
720465 -
720466 - a) Angina, class II- III 10/2/09
720468 - ..
720469 - b) Abnormal TMST, relatively low work load 9/16/09
720471 - ..
720472 - c) CABGx4v 10/22/09 SFVA (LIMA-->LAD, SVG-->diag,
720473 - SVG-->Ramus,SVG-->PDA).
720475 - ..
720476 - 2. Hyperlipidemia
720478 - ..
720479 - 3. Achalasia, S/P laparoscopic myotomy with fundoplication at
720480 - the San Francisco VA December 2009. Subsequently recurrent
720481 - stricture most recently noted at EGD 2/18/11.
720483 - ..
720484 - 4. PACs with exercise on ETT 4/6/11
720486 - ..
720487 - 2. The patient was last seen in clinic on 10/2/9 , A&P as follow:
720489 - ..
720490 - This part of Progress Notes repeats from prior notes on 091002...
720491 -
720492 - 1. Discussion:................ 091002 0900, ref SDS 11 7S8M
720493 -
720494 - Given pts. history and exercise ECG very little doubt in my
720495 - mind that his symptoms are due to underlying CAD. We have
720496 - agreed to cross our fingers that it may be amenable to PCI
720497 - but I suspect TVD +/- LMD which will require surgery.
720498 - Explained results of tests and full spectrum of
720499 - possibilites to pt. and his wife with a good understanding.
720500 - He has agreed with consultation to SFVA for cor angiography
720501 - with PCI if possible.
720503 - ..
720504 - 2. PLAN:....................... 091002 0900, ref SDS 11 IZ4F
720505 -
720506 - 1) ASA 325 mg daily if possible. If unable, will try 81
720507 - mg bid
720508 -
720509 - 2) Continue simvastatin as well as able.
720511 - ..
720512 - 3) Consult SFVA for cor angio.
720514 - ..
720515 - 4) Asked to refrain from hiking until diagnostic studies
720516 - completed because of potential risk of arrhythmia in an
720517 - isolated location.
720519 - ..
720520 - 5) Rx: NTG 0.4 mg sl prn cp not responding to a brief
720521 - period of rest. If no relief with one NTG to call 911.
720523 - ..
720524 - 6) RTC post cath/intervention.
720526 - ..
720527 - Remainder of Progress Notes pertain to meeting today on 110309...
720528 -
720529 - 3. Cardiac cath revealed triple vessel disease with bifurcation
720530 - lesions (95% RCA, 70% Ramus, 70%D1, 95% LAD with TIMI 2 flow.)
720531 -
720532 - 4. Subsequently underwent CABGx4v 10/22/09 (LIMA-->LAD,
720533 - SVG-->diag, SVG-->Ramus, SVG-->PDA).
720535 - ..
720536 - CABG was performed at VA San Francisco Medical Center on 091022.
720537 - ref SDS 13 PQWU
720539 - ..
720540 - Onset reported to VA on 090908 1130. ref SDS 10 MY4N
720542 - ..
720543 - VA Progress Notes Cardiology meeting 110309 continue...
720544 -
720545 - 5. Currently doing well in general. Hiking, trying to lose some
720546 - weight, was down to 165# post-CABG. Not taking asa but no side
720547 - effects with it previously. Had some post-op atrial fib,
720548 - resolved but in November he experienced mild sx suggestive of
720549 - those he experienced with the arrythmia (chest rocking when
720550 - supine).
720552 - ..
720553 - 6. No history of dizziness, lightheadedness or syncope. No focal
720554 - neurologic symptoms
720556 - ..
720557 - 7. No history suggestive of angina pectoris.
720559 - ..
720560 - 8. Denies DOE, PND, Orthopnea, Edema.
720562 - ..
720563 - 9. PAST MEDICAL HISTORY:
720564 -
720565 - 1. Computerized Problem List is the source for the following:
720566 -
720567 - 1. Esophageal Stricture 03/05/10 LEE,RANDALL E
720569 - ..
720570 - 2. Screening for Malignant Neoplasms of colon 11/15/11
720571 - LEE,RANDALL E (ICD-9-CM V76.51)
720572 -
720573 - 2010 colonoscopy: no polyp. Next screen 2020
720575 - ..
720576 - 3. Coronary Atherosclerosis (unspecified type 02/02/10
720577 - LEE,RANDALL E vessel, native or graft) (ICD-9-CM 41
720579 - ..
720580 - 4. Coronary Artery Bypass using Venous and 01/04/10
720581 - SANDHU,HARKESH Arterial Grafts (Single Vein Graft),
720582 - Onset 10/00/09 done at vasf
720584 - ..
720585 - CABG was performed at VA San Francisco Medical Center on 091022.
720586 - ref SDS 13 PQWU
720588 - ..
720589 - Onset reported to VA on 090908 1130. ref SDS 10 MY4N
720591 - ..
720592 - VA Progress Notes Cardiology meeting 110309 continue...
720593 -
720594 - 5. Surgical Thoracoscopy with Esophagomyotomy 01/04/10
720595 - SANDHU,HARKESH (Heller Type), Onset 12/16/09 at vasf
720597 - ..
720598 - 6. Hyperlipidemia * (ICD-9-CM 272.4) 10/02/09 EGAN,JAMES
720600 - ..
720601 - 7. Inflamed Seborrheic Keratosis (ICD-9-CM 702.11)
720602 - 03/12/07 LIN,BERTHA
720604 - ..
720605 - 8. Rosacea * (ICD-9-CM 695.3) 03/12/07 LIN,BERTHA
720607 - ..
720608 - 9. Dermatitis * (ICD-9-CM 692.9) 03/12/07 LIN,BERTHA
720610 - ..
720611 - 10. Tinea Unguium * (ICD-9-CM 110.1) 03/12/07 LIN,BERTHA
720613 - ..
720614 - 11. Tinea * (ICD-9-CM 110.9) 03/12/07 LIN,BERTHA
720616 - ..
720617 - 12. Rosacea conjunctivitis (ICD-9-CM 372.31) 03/02/07
720618 - MARGULIES,LINDA
720620 - ..
720621 - 13. Rosacea * (ICD-9-CM 695.3) 03/02/07 MARGULIES,LINDA
720623 - ..
720624 - 14. Blepharitis NOS 02/21/07 MARGULIES,LINDA
720626 - ..
720627 - 15. Achalasia * (ICD-9-CM 530.0) 12/22/05 SANDHU,HARKESH
720629 - ..
720630 - 16. Abn. LFT's 08/16/05 SANDHU,HARKESH
720632 - ..
720633 - 17. Obesity 06/29/05 SANDHU,HARKESH
720635 - ..
720636 - 18. Rosacea 06/29/05 SANDHU,HARKESH
720638 - ..
720639 - 19. Tinea Unguium 06/29/05 SANDHU,HARKESH
720641 - ..
720642 - 2. Patient has answered NKA (no known allergies)
720644 - ..
720645 - 10. Active Outpatient Medications (including Supplies):
720646 -
720647 - 1. OMEPRAZOLE 20MG EC CAP TAKE TWO CAPSULES BY MOUTH TWICE A
720648 - ACTIVE DAY 15 MINUTES BEFORE A MEAL FOR SEVERE ACID REFLUX
720649 - AND ESOPHAGEAL NARROWING. **DOSE INCREASE**
720651 - ..
720652 - 2. SIMVASTATIN 80MG TAB TAKE ONE-HALF TABLET BY MOUTH EVERY
720653 - ACTIVE EVENING - FOR CHOLESTEROL*USE PILL CUTTER* DO NOT
720654 - TAKE WITH GRAPEFRUIT JUICE.
720656 - ..
720657 - 11. PHYSICAL EXAM - Date: 110309 0903
720658 -
720659 - T....................... 98.4 (36.9 C)
720660 - P....................... 60
720661 - R....................... 20
720662 - B/P..................... 123/70
720663 - Wt...................... 200.00 (90.91 KG)
720664 - Body Mass Index......... 32*
720665 - Pulse Oximetry.......... 98%
720666 - Pain.................... 0 - No pain
720668 - ..
720669 - 12. Head atraumatic, PERRL.
720670 - Carotid upstrokes normal, no bruits noted
720671 - Thyroid normal to palpation.
720672 - JVP wnl.
720673 - Cor:Regular, No ectopy. Grade 1-2 msm lsb, increases with
720674 - inspiration, suggests TR.
720675 - Lungs clear of rales, ronchi and wheezes.
720676 - Extremities without cyanosis, clubing or edema.
720678 - ..
720679 - 13. Collection DT Spec CHOL TRIGLYC HDL LDL-CHO
720680 - 12/07/2010 09:17 PLASM 151 41 47 96
720681 - 07/21/2010 08:54 PLASM 261 H 87 35 L 209 H
720683 - ..
720684 - These valuations align with VA lab on 101207 0906. ref SDS 61 E19L
720686 - ..
720687 - VA Progress Notes Cardiology meeting 110309 continue...
720688 -
720689 - 14. PLASMA 12/07
720690 - 2010
720691 - 09:17 Units Range
720692 - -------------------------------------------------------------
720693 - GLUCOSE 102 mg/dL 74 - 118
720694 - GLUfast mg/dL Ref: <=99
720695 - NA (salt) 137 mmol/L 136 - 144
720696 - K 3.8 mmol/L 3.4 - 4.8
720697 - CL 104 mmol/L 98 - 106
720698 - CO2 28 mmol/L 23 - 33
720699 - BUN 8 mg/dL 8 - 26
720700 - CREAT 0.85 mg/dL .5 - 1.1
720701 - eGFR >60 mL/min Ref: >=60
720702 - CALCIUM 8.4 L mg/dL 8.7 - 10.2
720703 - CA CORR mg/dL 8.7 - 10.2
720704 - PO4 mg/dL 2.4 - 4.5
720705 - MG mg/dL 1.8 - 2.5
720706 - ALK PHO 102 IntUnits/L 37 - 107
720707 - T. BIL 1.0 mg/dL .3 - 1.2
720708 - D. BILI mg/dL .1 - .4
720709 - AST 26 IntUnits/L 8 - 42
720710 - ALT 22 IntUnits/L 5 - 55
720711 - ALBUMIN 3.9 g/dL 3.3 - 4.8
720712 - PROTEIN 7.2 g/dL 6.5 - 8.1
720714 - ..
720715 - 15. Collection DT Spec WBC HGB HCT MCV MCHC PLT
720716 - 12/07/2010 09:17 BLOOD 6.7 14.4 43.3 90.7 33.1 310
720717 - 07/21/2010 08:54 BLOOD 7.3 14.9 44.0 91.2 33.8 344
720719 - ..
720720 - 16. EKG Date: 11/17/09 @ 1558
720721 - Vent Rate: 62 PR Interval: 166
720722 - QRS Duration: 82 QT: 430
720723 - QTC: 436 P Axis: 42
720724 - R Axis: 8 T Axis: 75
720725 - Confirmation Status: Interpreted By: URSELL,SHANTHA N
720727 - ..
720728 - 17. Auto Instrument Diagnosis:
720729 -
720730 - Normal sinus rhythm
720731 - Nonspecific T wave abnormality
720732 - Abnormal ECG
720733 - When compared with ECG of 02-NOV-2009 07:43,
720734 - Nonspecific T wave abnormality no longer evident in Inferior leads
720735 - T wave inversion no longer evident in Anterior leads
720736 - Confirmed by URSELL MD, SHANTHA (703) on 11/18/2009 11:51:16 AM
720738 - ..
720739 - Auto Instrument Data?:
720740 - Primary Provider: URSELL,SHANTHA N
720742 - ..
720743 - 18. ASSESSMENT:
720744 -
720745 - 1. CAD,S/P CABG, asymptomatic
720746 -
720747 - 2. Hyperlipidemia, most recent lab does not demonstrate
720748 - adequate control, should target LDL< 70 mg dl as primary
720749 - goal
720751 - ..
720752 - 3. Palpitations in November uncertain etiology.
720753 -
720755 - ..
720756 - 19. PLAN:
720757 -
720758 - 1. Current medications reconciled.
720760 - ..
720761 - 2. Discussed pros and cons of chronic asa, strongly
720762 - indicated permanently from my point of view unless
720763 - complicateions such as GI upset or bleed. He agrees to
720764 - reinitiate 81 mg daily
720766 - ..
720767 - 3. Advise that we should increase simvastatin to 80 mg,
720768 - prefers to continue with weight loss and exercise to see if
720769 - he can bring LDL to target.
720771 - ..
720772 - 4. Holter, r/o silent atrial fibrillation.
720774 - ..
720775 - 5. ETT as new baseline.
720777 - ..
720778 - 6. Will RTC shortly after HM and ETT.
720779 -
720780 - 20. /es/ James Egan, MD
720781 - Staff Physician, Cardiology
720782 - Signed: 03/09/2011 09:51
720783 -
720784 -
720785 -
720786 -
720787 -
720788 -
720789 -
720790 -
720791 -
720792 -
720793 -
720794 -
720795 -
7208 -