Name: Brigoli, Moira Jullianne S.

Date: January 16, 2023

Subject: NUR 115: NURSING INFORMATICS
Activity #: 1

CARDIOLOGY CONSULTATION

Diagnosis:
One: Mitral valve disease, common status: post mitral valve replacement with a St.
Jude's prosthetic valve and coronary artery bypass (times) one [in the hospital]

Two: History of two previous cerebrovascular accidents secondary to embolic

disorder from inadequate anticoagulation.

Three: Atrial fibrillation on Coumadin with INR 3.1.

Four: Possible TIA, on yesterday, with right arm weakness and numbness.

Subjective:
Beginning to put this patient returns to the Cardiology clinic and does not feel
well today. He thinks that he had a TIA yesterday in which he had sudden right arm
weakness. His EKG today shows atrial fibrillation with a controlled ventricular
response, and T wave inversions consistent with ischemia. 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 appear reasonable
to stop this medication. Patient occasionally has angina about twice a month
relieved by nitroglycerin. Patient is followed by Dr. (inaudible). Patient had a
cardiac echo(cardiogram) done and in this study left ventricular function was seen
to be normal.

Objective:
Prosthetic mitral valve tilting disc variety was working well and there was a
question of an atrial septal defect. However, this was not at all documented and
the mitral valve appears to function well and the patient was in atrial
fibrillation at that time.

Physical examination today: BP is 149/69 mmhg left, 167/72 mmhg right, pulse 89
and the regular weight 180 lbs. Chest is clear. Cardiac examination reveals good
prosthetic clicks of the mitral valve prosthesis.

Comments/Recommendations:
There is a low-pitched rumble in the diastole which is appropriate. There is no
mitral regurgitation clinically. There is no edema.

Comments and recommendations: As the patient knows with mitral valve replacement
and atrial fibrillation, INR should be 3.5 to 4.5, especially in the setting of
previous embolic episodes. EKG suggesting ischemia is of concern and the patient
should probably have a Thallium imaging study.

Plan:
In fact, my plan will be to stop sotalol since the patient has been chronically in
atrial fibrillation, we place them on metoprolol XL 25 mg per day for hypertensive
control which may be increased. I am going to give the patient a copy of his EKG
and suggest to them very strongly that he see his primary local private
cardiologist doctor for consideration of Thallium imaging, possibly
transesophageal echo(cardiogram) to assess mitral valve, possible DC



cardioversion. I will plan a Cardiology follow up in our clinic and my next

available slot is probably six to nine months to review the patient.

I am not going to order a repeat echo. End.