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April 04, 2010
Heart Transplant Progress
This is an update of my Heart Failure status and my efforts to become eligible to the Heart Transplant List.
Consult Note - 10/14/2009
Provider: Heart Failure and Cardiac Transplantation Center
*** Interval History
This is a 57-year-old gentlemen with advanced cardiomyopathy since 1995 with CHF class III-IV, whose ejection fraction has been documented to be 10%-15%. He underwent cardiac catheterizaton in January 2009, which showed diffuse coronary disease of his arteries not amenable to stenting. His last echo was in June 2008, which showed fairly decreased left ventrical soft systolic function, dilated left atrium along with moderate-to-severe mitral regurge, and ejection fraction of 15%. He has had two to three hospital admissions - moreso for pulmonary edema. He is not on Coumadin due to bleeding.
His New York Heart Association Class does remain III. He is now a non-smoker and non-alcohol drinker. He has documented three-vessel disease. He has been compliant with medications and shows good awareness of his disease. His cath reveals the following: Left main coronary artery has a proximal large ulceration and a distal 70% stenosis. His left anterior decending artery has diffuse mild disease at proximal segment with a total occlusion of the right after the first diagonal. The first diagonal is a moderate caliber vessel with diffuse mild disease and no significant obstruction. The left circumflex is a codominant vessel, large in caliber. The first obtruse marginal has a proximal total stenosis. There is diffuse mild disease involving the distal segment, the second obtuse marginal has a long proximal 70% stenosis. There are collaterals from left to left and from left to right. The right coronary had a proximal total occlusion. The left ventriclar angiogram is not performed. There was not a right heart catherization done at this time.
*** Past Medical History
Significant for CHF class III, diabetes (type 2) insulin treatment, three-vessel coronary disease, cardiomyopathy, ICD [implantable cardioverter defibrillator], persistent atrial fibrillation, sleep apnea, COPD, GERD, and intolerance of Coumadin therapy.
*** Procedures
Electrocardiogram: shows atrial fibrillation with controlled rate.
*** Assessment and Plan
This is a 57-year-old gentlemen with advanced cardiomyopathy class III, stage D, who has an appropriate defibrillator, is currently being maxed on medications by his cardiologist. He would need a right heart catheterization, as well as maximal exercise test to determine if he is nearing need for transplantation. His barriers to transplant would of course be his past alcohol use with possible damage to his liver, as well as chronic smoking with damage to his lungs.
He will see me again in six months.
*** Medication List
coreg 25mg 2x, lisinopril 5mg 1x, furosemide 80mg 1x, digoxin 0.375mg 1x, crestor 20mg 1x, aspirin 325mg 1x, protonix, insulin etc
An Inch From Murder Book is Here
Posted by Nealus at April 4, 2010 07:51 AM
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