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Routine: DVBCWAM3

DVBCWAM3.m

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DVBCWAM3 ;ALB/RLC ARRHYTHMIAS WKS TEXT - 1 ; 11 FEB 1997

 ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8

 ;

 ;

TXT ;

 ;;A.  Review of Medical Records:

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;

 ;;    1.  Describe type of arrhythmia and onset of disorder.  Indicate whether

 ;;        arrhythmia is intermittent or continuous.

 ;;    2.  Describe hospitalization or surgery for arrhythmia, including location,

 ;;        date, type of surgery, reason for hospitalization.

 ;;    3.  For intermittent arrhythmia, state frequency and duration of episodes,

 ;;        and for supraventricular arrhythmia, state how many episodes per year

 ;;        have been confirmed by EKG or Holter monitor?

 ;;    4.  Is a pacemaker present?  If so, when was it inserted, effectiveness,

 ;;        side effects?

 ;;    5.  Is an AICD (automatic implantable Cardioverter-Defibrillator) present?

 ;;        If so, when was it implanted, effectiveness, side effects?

 ;;    6.  Describe other treatment, including RF (radiofrequency) ablation, type,

 ;;        effectiveness, and side effects?  Is continuous medication required?

 ;;    7.  Is there a history of congestive heart failure?  If so, state whether

 ;;        chronic or not.  If not chronic, how many episodes have there been in

 ;;        the past 12 months?

 ;;    8.  Sustained ventricular arrhythmias, atrioventricular

 ;;        block, and implantable cardiac pacemakers (if ventricular

 ;;        arrhythmia or atrioventricular block was the reason for the

 ;;        pacemaker) require that the examiner provide the METs level,

 ;;        determined by exercise testing, at which symptoms of dyspnea, 

 ;;        fatigue, angina, dizziness, or syncope result.

 ;;

 ;;        Exercise testing is not required for these 3 conditions in the

 ;;        following circumstances:

 ;;

 ;;           a.  If exercise testing is medically contraindicated:

 ;;

 ;;               i.  In that case, provide the medical reason exercise

 ;;                   testing cannot be conducted, and

 ;;              ii.  Provide an estimate of the level of activity

 ;;                   (expressed in METs and supported by specific

 ;;                   examples, such as slow stair climbing, or

 ;;                   shoveling snow) that results in dyspnea, fatigue,

 ;;                   angina, dizziness, or syncope.

 ;;

 ;;           b.  If left ventricular dysfunction is present, and the 

 ;;               ejection fraction is 50 percent or less.

 ;;           c.  If there is chronic congestive heart failure or there

 ;;               has been more than one episode of acute congestive

 ;;               heart failure in the past year.

 ;;           d.  With valvular heart disease - during active infection

 ;;               with valvular heart damage and for three months

 ;;               following cessation of therapy for the active 

 ;;               infection.

 ;;           e.  With endocarditis - for three months following

 ;;               cessation of therapy for active infection with cardiac

 ;;               involvement.

 ;;           f.  With pericarditis - for three months following

 ;;               cessation of therapy for active infection with cardiac

 ;;               involvement.

 ;;           g.  With myocardial infarction - for three months

 ;;               following myocardial infarction.

 ;;           h.  With valve replacement - for six months following date

 ;;               of hospital admission for valve replacement.

 ;;           i.  With coronary bypass surgery - for three months

 ;;               following hospital admission for surgery.

 ;;           j.  For cardiac transplantation - for indefinite period

 ;;               from date of hospital admission for cardiac

 ;;               transplantation.

 ;;           k.  If an exercise test has been done within the past

 ;;               year, the results are of record, and there is no

 ;;               indication that there has been a change in the cardiac

 ;;               status of the veteran since.

 ;;

 ;;    9.  Other significant history.

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    Address each of the following and fully describe current findings:

 ;;

 ;;    1.  Vital signs; heart size and method of determination; heart

 ;;        sounds, rate and rhythm, blood pressure.

 ;;    2.  Status of cardiac function - evidence of congestive heart

 ;;        failure.

 ;;    3.  Other significant physical findings.

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;  

 ;;    1.  EKG.

 ;;    2.  Was testing for left ventricular function done?  If so,

 ;;        report the ejection fraction.

 ;;    3.  Holter monitor, other tests as indicated.

 ;;    4.  Chest X-ray or other imaging study, exercise stress test,

 ;;        echocardiogram, Holter monitor, thallium study, angiography,

 ;;        etc., as appropriate, and as required or indicated.

 ;;    5.  Include results of all diagnostic and clinical tests

 ;;        conducted in the examination report, including status of

 ;;        left ventricular function, if measured.

 ;;

 ;;E.  Diagnosis:

 ;;  

 ;;    1.  Type of cardiac arrhythmia, if present.  Confirmed by EKG or

 ;;        Holter monitor?

 ;;    2.  Other diagnoses.

 ;;    3.  Describe the effects of each diagnosed condition on the

 ;;        veteran's usual occupation and daily activities.

 ;;

 ;;

 ;;

 ;;Signature:                                        Date:

 ;;END