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Routine: DVBCWHE1

DVBCWHE1.m

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  1. DVBCWHE1 ;ALB/JFP HEART WKS TEXT - 1 ; 12 FEB 1998
  1.  ;;2.7;AMIE;**16**;Apr 10, 1995
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;A.  Review of Medical Records:
  1.  ;;
  1.  ;;B.  Medical History (Subjective Complaints):
  1.  ;;    Comment on:
  1.  ;;    1.  Past history - describe onset of disorder and frequency of
  1.  ;;        cardiac symptoms, including angina, dyspnea, fatigue,
  1.  ;;        dizziness, and syncope.  Record dates and severity of
  1.  ;;        episodes of acute cardiac illness, including myocardial
  1.  ;;        infarction, congestive heart failure, and acute rheumatic 
  1.  ;;        heart disease.  Describe all cardiac surgery, including
  1.  ;;        coronary artery bypass, valvular surgery, cardiac transplant,
  1.  ;;        and angioplasty.
  1.  ;;    2.  Current treatment - type, dosage, response, and side effects.
  1.  ;;    3.  With the exceptions given below, examinations for valvular
  1.  ;;        heart disease, endocarditis, pericarditis, pericardial
  1.  ;;        adhesions, syphilitic heart disease, arteriosclerotic heart
  1.  ;;        disease, myocardial infarction, hypertensive heart disease,
  1.  ;;        heart valve replacement, coronary bypass sugery, cardiac
  1.  ;;        transplanation, and cardiomyopathy, require the examiner to
  1.  ;;        provide the METs level, determine by exercise testing, at
  1.  ;;        which symptoms of dyspnea, fatigue, angina, dizziness, or
  1.  ;;        syncope result. 
  1.  ;;    4.  Exercise testing is not required for the above listed
  1.  ;;        conditions in the following circumstances:
  1.  ;;          a. If exercise testing is medically contraindicated:
  1.  ;;             1)  In that case, provide the medical reason exercise
  1.  ;;                 testing cannot be conducted, and
  1.  ;;             2)  Provide an estimate of the level of activity
  1.  ;;                 (expressed in METs and supported by specific
  1.  ;;                 examples, such as slow stair climbing, or shoveling
  1.  ;;                 snow) that results in dyspnea, fatigue, angina,
  1.  ;;                 dizziness, or syncope.
  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 has
  1.  ;;             been more than one episode of acute congestive heart
  1.  ;;             failure in the past year.
  1.  ;;          d. With valvular heart disease - during active infection
  1.  ;;             with valvular heart damage and for three months following
  1.  ;;             cessation of therapy for the active infection.
  1.  ;;          e. With endocarditis - for three months following cessation
  1.  ;;             of therapy for active infection with cardiac involvement.
  1.  ;;          f. With pericarditis - for three months following cessation
  1.  ;;             of therapy for active infection with cardiac involvement.
  1.  ;;          g. With myocardial infarction - for three months following
  1.  ;;             myocardial infarction.
  1.  ;;          h. With valve replacement - for six months following date of
  1.  ;;             hospital admission for valve replacement.
  1.  ;;          i. With coronary bypass surgery - for three months following
  1.  ;;             hospital admission for surgery.
  1.  ;;          j. For cardiac transplantation - for indefinite period from
  1.  ;;             date of hospital admission for cardiac transplantation.
  1.  ;;          k. If an exercise test has been done within the past year,
  1.  ;;             the results are of record, and there is no indication
  1.  ;;             that there has been a change in the cardiac status of the
  1.  ;;             veteran since.
  1.  ;;    5.  For hyperthyroid heart disease, if atrial fibrillation is
  1.  ;;        present, use arrhythmia worksheet.  Also use endocrine
  1.  ;;        worksheet if examining for hyperthyroidism.
  1.  ;;    6.  Describe the effects of the condition on the veteran's usual
  1.  ;;        occupation and daily activities.
  1.  ;;    7.  Even when special examinations and tests (e.g., exercise
  1.  ;;        testing) are not required under the worksheet guidelines, they
  1.  ;;        may be requested or conducted at the discretion of the
  1.  ;;        examiner, when the examiner believes that the available
  1.  ;;        information does not fully reflect the severity of the
  1.  ;;        veteran's cardiovascular disability.
  1.  ;;
  1.  ;;C.  Physical Examination (Objective Findings):
  1.  ;;    Address each of the following and fully describe current findings:
  1.  ;;    1.  Heart size and method of determination, heart rhythm and rate,
  1.  ;;        heart sounds, blood pressure.
  1.  ;;    2.  Evidence of congestive heart failure - rales, edema, liver
  1.  ;;        enlargement, etc.
  1.  ;;
  1.  ;;D.  Diagnostic and Clinical Tests:
  1.  ;;    1.  Chest X-ray, EKG, exercise stress test, echocardiogram,
  1.  ;;        Holter monitor, thallium study, angiography, etc., as
  1.  ;;        appropriate, and as required or indicated.
  1.  ;;    2.  Include results of all diagnostic and clinical tests
  1.  ;;        conducted in the examination report, including status of left
  1.  ;;        ventricular function, if measured.
  1.  ;;    3.  Valvular heart disease and endocarditis require documentation
  1.  ;;        of diagnosis by physical findings and either echocardiogram,
  1.  ;;        Doppler echocardiogram, or cardiac catheterization, if not
  1.  ;;        already of record.  
  1.  ;;    4.  Other types of heart disease must be documented by appropriate
  1.  ;;        objective diagnostic tests.
  1.  ;;
  1.  ;;E.  Diagnosis and Opinion:
  1.  ;;    1.  Type of heart disease and etiology, if known.
  1.  ;;    2.  Type of surgery, if any, and results.
  1.  ;;    3.  If the veteran is service-connected for rheumatic heart
  1.  ;;        disease and later develops non-service-connected
  1.  ;;        arteriosclerotic heart disease, state, if possible, which
  1.  ;;        cardiac findings can be attributed to each condition.  If it
  1.  ;;        is not possible to separate the signs and symptoms of one
  1.  ;;        from the other, so state, and explain.
  1.  ;;
  1.  ;;
  1.  ;;Signature:                                        Date:
  1.  ;;END