DATE OF CONSULTATION: MM/DD/YYYY
REFERRING PHYSICIAN: John Doe, MD
REASON FOR CONSULTATION: Paroxysmal supraventricular tachycardia.
HISTORY OF PRESENT ILLNESS: The patient is a (XX)-year-old female with no known history of coronary artery disease or history of arrhythmia, who came in today for elective angiogram and subsequent angioplasty for peripheral vascular disease. The patient was in the recovery room and had an asymptomatic, self-terminating episode of narrow complex tachycardia at approximately 150 beats per minute. The initiating beat appeared to be an ectopic atrial beat. The patient was asymptomatic, and this episode terminated on its own. She has no history of arrhythmia and never had any cardiac testing done in the past. The patient does have a pertinent history of hypertension, dyslipidemia and peripheral vascular disease.
PAST MEDICAL AND SURGICAL HISTORY: Hypertension, dyslipidemia, PVD as above and C-section.
ALLERGIES: She has no known drug allergies.
MEDICATIONS: Plavix 75 mg daily, aspirin 81 mg daily, Hyzaar 50/12.5, Pravachol 40 mg, and she is on Lodine.
SOCIAL AND FAMILY HISTORY: The patient is divorced and lives with her daughter. No family history of CAD or sudden cardiac death. She does not drink. She quit smoking tobacco years ago.
REVIEW OF SYSTEMS: No chest pain. No shortness of breath. No palpitations. No stroke or TIA. No blood in the stool or urine. The patient is able to walk from her car to her home without chest pain, shortness of breath or limiting factors such as claudication. From a peripheral vacular standpoint, the patient had bilateral stents placed in the past in her common iliac arteries and underwent successful angioplasty of the right common internal iliac artery earlier today for reocclusion.
PHYSICAL EXAMINATION:
VITAL SIGNS: BP is 154/62, respirations 18, and pulse is 86.
GENERAL: The patient is lying in bed, in no acute cardiovascular distress.
HEENT: Sclerae nonicteric.
NECK: No jugular venous distension. No carotid bruits.
HEART: Revealed normal S1 and S2. There was a soft 1/6 systolic murmur over the base.
LUNGS: Clear to auscultation bilaterally.
ABDOMEN: Has a well-healed surgical scar in the midline. It is otherwise unremarkable, other than being slightly obese.
EXTREMITIES: Without clubbing, cyanosis or edema. Bilateral groins have dressings in place that are clean, dry and intact. Moving all four extremities.
NEUROLOGIC: She is nonfocal.
DIAGNOSTIC DATA: Electrocardiogram reveals sinus rhythm at 84 beats per minute with normal intervals and normal ST segment.
LABORATORY DATA: Potassium 3.5, creatinine 0.8, and hemoglobin 13.8.
IMPRESSION: The patient is a (XX)-year-old female with no known history of coronary artery disease or arrhythmia, who has hypertension, dyslipidemia and peripheral vascular disease status post angioplasty to common iliac earlier today, who had asymptomatic, self-terminating run of narrow complex tachycardia while in the recovery room awaiting to go home. The differential diagnosis at this time includes atrial flutter versus an ectopic atrial tachycardia versus another form of paroxysmal supraventricular tachycardia.
RECOMMENDATIONS:
1. We will recommend observing the patient on telemetry overnight for further evidence of arrhythmia. If arrhythmia recurs, we have placed an order for 12-week rhythm strip to be obtained.
2. Two-dimensional echocardiogram has been ordered.
3. Routine laboratory data, including fasting lipid profile and TSH, has been ordered.
4. Home medications to be continued.
At this time, we feel that she does not need antiarrhythmic therapy or anticoagulation therapy. Further recommendations in regard to those therapeutic modalities will be made after the observation and the echocardiogram are done.
