CC:MyChart
video
Second degree AVB
s/p DCPM with His lead
12/2019
HISTORY OF PRESENT
ILLNESS:
Donald is a 73 year old
male with a history of
DM, CAD, 2:1 AV block
s/p DCPM. He was
diagnosed with afib at a
10/2019 office visit
with Dr. Poku, he was
started on Eliquis and
sent home with a 30 day
monitor, he was
found to have long runs
of 2:1 second degree AV
block
(no afib noted) s/p DCPM
with a His lead in
12/2019. An outside echo
from 11/2019 shows an EF
of 56%.
He follows with Dr. Poku.
He follows up today via
MyChart with no
cardiac
complaints and
is
feeling well. Denies CP,
fatigue, dizziness,
lightheadedness,
syncope, near syncope.
Home SBP on average is
150. Dr. Poku
recommended holding
Eliquis 7/2020 as no
afib has been identified
on home monitoring.
Past Medical
History:
Diagnosis
Date
Atrial
fibrillation
(HCC)
Benign
nodular
prostatic
hyperplasia
with lower
urinary
tract
symptoms
CAD
(coronary
artery
disease)
Chest pain,
precordial
CHF
(congestive
heart
failure) (HCC)
Coronary
atherosclerosis
of native
coronary
artery
Diabetes
mellitus (HCC)
Essential
hypertension,
benign
Lumbago
Mixed
hyperlipidemia
PAC
(premature
atrial
contraction)
Palpitation
PVC
(premature
ventricular
contraction)
Reflux
esophagitis
Past
Surgical
History:
Procedure
Laterality
Date
BACK SURGERY
CARDIAC
PACEMAKER
PLACEMENT
Left
12/17/2019
CORONARY
ANGIOPLASTY
WITH STENT
PLACEMENT
CORONARY
ARTERY
STENTING
KNEE SURGERY
LAP,CHOLECYSTECTOMY
Family
History
Problem
Relation
Age of Onset
Stroke
Mother
Hyperlipidemia
Mother
Hypertension
Mother
Hyperlipidemia
Father
Hypertension
Father
Social
History
Tobacco Use
Smoking
status:
Former
Smoker
Smokeless
tobacco:
Never Used
Substance
Use Topics
Alcohol use:
Yes
Alcohol/week:
0.0 standard
drinks
Drug use:
No
No Known Allergies
Outpatient
Medications
Marked as
Taking for
the 10/8/20
encounter
(Telemedicine)
with Roger
Alan
Freedman, MD
Take 400
Units by
mouth Daily.
Indications:
Deficiency
of Vitamin E
ROS
A complete 12 point ROS
was performed and the
only pertinent findings
are included in the HPI.
PHYSICAL EXAM
Ht 182.9 cm (6') | Wt
95.3 kg (210 lb) | BMI
28.48 kg/m²
GENERAL: no apparent
distress.
PSYCH: appropriate mood,
appropriate affect.
DATA
Echo (11/4/19):
EF 56%
30 Day Event Monitor (11/15/2019):
-The study is a 30-day
mobile cardiac telemetry
ordered for paroxysmal
atrial fibrillation.
-There were a total of
66 events transmitted
during the monitoring
period, including the
baseline transmission.
-The baseline
transmission
demonstrated sinus
rhythm at 68 bpm with
second degree AV block
type I (Wenckebach), and
isolated ventricular
premature complexes.
-The average heart rate
for the monitoring
period was 52 bpm (min
28 - max 100).
-There were 2
patient-activated
transmissions with
reported symptoms of
rapid heartbeat and the
corresponding rhythm
strips showed: sinus
rhythm with 2:1 AV
block, isolated
ventricular premature
complexes, and sinus
rhythm with first degree
AV block
-There were 63
auto-detected
transmissions with the
corresponding rhythm
strips showing: sinus
rhythm with second
degree AV block type I
(Wenckebach), episodes
of 2:1 AV conduction,
episodes of high grade
second degree AV block
with junctional escape
beats (min of 31 bpm),
13 significant pauses
(longest 5.8 seconds),
and isolated ventricular
premature complexes.
-No atrial fibrillation
detected. Total
ventricular ectopy was
7%.
-Last data transmission
was recorded on 12/14/19
(Day 30).
DEVICE ANALYSIS
Reviewed by us today.
Full report in device
progress note.
IMPRESSION AND PLAN
1)Second degree AV s/p
DCPM with His lead
12/2019
-Normal device function
per remote check.
-AP
42%, HisP
97.1%.
-Programmed MVP, change
with next in person
visit to DDD.
-No atrial or
ventricular episodes.
-Battery estimating 5.4
yrs as well.
-Continue home
monitoring.
-Follow up in 6 months
with in person visit.
2) pAF
-No atrial episodes on
device check, no AF
noted on 11/2019 MCT.
-Dr. Poku has stopped
Eliquis, presumably for
lack of evidence of afib.
-CHADSVASc 4 (CAD, age,
HTN, DM).
-Continue to monitor and
discuss resuming Eliquis
if indicated.
3) HLD
4) CAD
-Pt on simvastatin,
10/2020 LDL above goal
at 118.
-Recommended he contact
Dr. Poku's team for
further management.
5) HTN
-BP above goal at home,
recommended he contact
Dr. Poku's team for
further management.
Due to the ongoing
COVID-19 pandemic, this
is a virtual telehealth
visit conducted via
MyChart. I spent
30
minutes in this
telehealth visit and on
related clinical
activities.
Kelly A Perkins, PA-C
I have personally
reviewed the history and
examined the patient
with the
dictator/creator of this
note. I have reviewed
and edited this note and
I attest that this
reflects my assessment
and plan or
recommendations.