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Routine: DVBCWAM3

DVBCWAM3.m

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  1. DVBCWAM3 ;ALB/RLC ARRHYTHMIAS WKS TEXT - 1 ; 11 FEB 1997
  1.  ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;A.  Review of Medical Records:
  1.  ;;
  1.  ;;B.  Medical History (Subjective Complaints):
  1.  ;;
  1.  ;;    1.  Describe type of arrhythmia and onset of disorder.  Indicate whether
  1.  ;;        arrhythmia is intermittent or continuous.
  1.  ;;    2.  Describe hospitalization or surgery for arrhythmia, including location,
  1.  ;;        date, type of surgery, reason for hospitalization.
  1.  ;;    3.  For intermittent arrhythmia, state frequency and duration of episodes,
  1.  ;;        and for supraventricular arrhythmia, state how many episodes per year
  1.  ;;        have been confirmed by EKG or Holter monitor?
  1.  ;;    4.  Is a pacemaker present?  If so, when was it inserted, effectiveness,
  1.  ;;        side effects?
  1.  ;;    5.  Is an AICD (automatic implantable Cardioverter-Defibrillator) present?
  1.  ;;        If so, when was it implanted, effectiveness, side effects?
  1.  ;;    6.  Describe other treatment, including RF (radiofrequency) ablation, type,
  1.  ;;        effectiveness, and side effects?  Is continuous medication required?
  1.  ;;    7.  Is there a history of congestive heart failure?  If so, state whether
  1.  ;;        chronic or not.  If not chronic, how many episodes have there been in
  1.  ;;        the past 12 months?
  1.  ;;    8.  Sustained ventricular arrhythmias, atrioventricular
  1.  ;;        block, and implantable cardiac pacemakers (if ventricular
  1.  ;;        arrhythmia or atrioventricular block was the reason for the
  1.  ;;        pacemaker) require that the examiner provide the METs level,
  1.  ;;        determined by exercise testing, at which symptoms of dyspnea, 
  1.  ;;        fatigue, angina, dizziness, or syncope result.
  1.  ;;
  1.  ;;        Exercise testing is not required for these 3 conditions in the
  1.  ;;        following circumstances:
  1.  ;;
  1.  ;;           a.  If exercise testing is medically contraindicated:
  1.  ;;
  1.  ;;               i.  In that case, provide the medical reason exercise
  1.  ;;                   testing cannot be conducted, and
  1.  ;;              ii.  Provide an estimate of the level of activity
  1.  ;;                   (expressed in METs and supported by specific
  1.  ;;                   examples, such as slow stair climbing, or
  1.  ;;                   shoveling snow) that results in dyspnea, fatigue,
  1.  ;;                   angina, dizziness, or syncope.
  1.  ;;
  1.  ;;           b.  If left ventricular dysfunction is present, and the 
  1.  ;;               ejection fraction is 50 percent or less.
  1.  ;;           c.  If there is chronic congestive heart failure or there
  1.  ;;               has been more than one episode of acute congestive
  1.  ;;               heart failure in the past year.
  1.  ;;           d.  With valvular heart disease - during active infection
  1.  ;;               with valvular heart damage and for three months
  1.  ;;               following cessation of therapy for the active 
  1.  ;;               infection.
  1.  ;;           e.  With endocarditis - for three months following
  1.  ;;               cessation of therapy for active infection with cardiac
  1.  ;;               involvement.
  1.  ;;           f.  With pericarditis - for three months following
  1.  ;;               cessation of therapy for active infection with cardiac
  1.  ;;               involvement.
  1.  ;;           g.  With myocardial infarction - for three months
  1.  ;;               following myocardial infarction.
  1.  ;;           h.  With valve replacement - for six months following date
  1.  ;;               of hospital admission for valve replacement.
  1.  ;;           i.  With coronary bypass surgery - for three months
  1.  ;;               following hospital admission for surgery.
  1.  ;;           j.  For cardiac transplantation - for indefinite period
  1.  ;;               from date of hospital admission for cardiac
  1.  ;;               transplantation.
  1.  ;;           k.  If an exercise test has been done within the past
  1.  ;;               year, the results are of record, and there is no
  1.  ;;               indication that there has been a change in the cardiac
  1.  ;;               status of the veteran since.
  1.  ;;
  1.  ;;    9.  Other significant history.
  1.  ;;
  1.  ;;C.  Physical Examination (Objective Findings):
  1.  ;;
  1.  ;;    Address each of the following and fully describe current findings:
  1.  ;;
  1.  ;;    1.  Vital signs; heart size and method of determination; heart
  1.  ;;        sounds, rate and rhythm, blood pressure.
  1.  ;;    2.  Status of cardiac function - evidence of congestive heart
  1.  ;;        failure.
  1.  ;;    3.  Other significant physical findings.
  1.  ;;
  1.  ;;D.  Diagnostic and Clinical Tests:
  1.  ;;  
  1.  ;;    1.  EKG.
  1.  ;;    2.  Was testing for left ventricular function done?  If so,
  1.  ;;        report the ejection fraction.
  1.  ;;    3.  Holter monitor, other tests as indicated.
  1.  ;;    4.  Chest X-ray or other imaging study, exercise stress test,
  1.  ;;        echocardiogram, Holter monitor, thallium study, angiography,
  1.  ;;        etc., as appropriate, and as required or indicated.
  1.  ;;    5.  Include results of all diagnostic and clinical tests
  1.  ;;        conducted in the examination report, including status of
  1.  ;;        left ventricular function, if measured.
  1.  ;;
  1.  ;;E.  Diagnosis:
  1.  ;;  
  1.  ;;    1.  Type of cardiac arrhythmia, if present.  Confirmed by EKG or
  1.  ;;        Holter monitor?
  1.  ;;    2.  Other diagnoses.
  1.  ;;    3.  Describe the effects of each diagnosed condition on the
  1.  ;;        veteran's usual occupation and daily activities.
  1.  ;;
  1.  ;;
  1.  ;;
  1.  ;;Signature:                                        Date:
  1.  ;;END