974381789
PUOMC
0520610
70648
390115
12/25/1996 12:00:00 AM
ATRIAL FIBRILLATION .
Unsigned
DIS
Report Status :
Unsigned
DISCHARGE SUMMARY
NAME :
LENKPRUSKIHKOOGLEKIH , NIEKERO C
UNIT NUMBER :
449-50-82
ADMISSION DATE :
12/25/96
DISCHARGE DATE :
12/29/96
PRINCIPAL DIAGNOSIS :
Atrial fibrillation .
ASSOCIATED DIAGNOSIS :
History of multinodular goiter ; history of hypertension ; history of subtotal thyroidectomy .
PRINCIPAL PROCEDURE :
Electrical cardioversion .
HISTORY OF PRESENT ILLNESS :
Ms. Lenkpruskihkooglekih is a 63-year-old lady with a history of frequent premature ventricular contractions and infrequent short runs of non-sustained ventricular tachycardia ( one four-beat run ) in 1991 , for which several antiarrhythmic agents including Propranolol , Quinidine , Procainamide , Tenormin , Norpace , Corgard , and Flecainide were used , but were stopped because of intolerance .
At that time , she had clear coronary arteries on coronary angiography and an ejection fraction greater than 50% .
She did well off antiarrhythmic agents until October of this year when she was noted to have atrial fibrillation with a rapid ventricular rate after several days of decreased exercise tolerance .
She was started on Coumadin and had a failed attempt at DC electrical cardioversion on 11/16/96 .
She has been on Coumadin since and has continued to have occasional palpitations and mild shortness of breath .
PAST MEDICAL HISTORY :
Includes a history of hypertension ; multinodular goiter ; subtotal thyroidectomy .
MEDICATIONS :
Include Cardizem CD 180 mg daily ; Monopril 10 mg daily ; Digoxin .25 mg daily ; and Lasix 40 mg every other day .
ALLERGIES :
To Quinidine , Procardia , and sulfa antibiotics .
PHYSICAL EXAMINATION :
On examination , blood pressure was 200/100 ; heart rate 120 per minute ( atrial fibrillation ) .
The patient was noted to be anxious .
There was no neck vein distension or carotid bruits .
Heart sounds were normal .
The lungs were clear .
The abdominal examination was benign .
There was no peripheral edema .
Pulses were all easily palpable .
LABORATORY DATA :
A 12-lead electrocardiogram showed atrial fibrillation with a QT interval of .46 seconds .
There were diffuse ST segment and T-wave abnormalities , which were nonspecific .
A complete blood count , electrolytes , BUN and creatinine were within normal limits .
INR was elevated at 2.5 .
An echocardiogram was performed , which showed completely normal left ventricular systolic function with an ejection fraction calculated at .74 .
There was no evidence of left ventricular hypertrophy or asymmetric septal hypertrophy , which had been an issue that had been raised on an echocardiogram in Ownra Cin , New Mexico on 12/06/96 .
HOSPITAL COURSE AND TREATMENT :
The patient was started on Propafenone 300 mg three times a day and underwent an attempt at electrical cardioversion after seven doses of this .
This failed , despite one shock at 300 joules and two shocks at 360 joules .
The Propafenone was stopped , and the patient was changed to Amiodarone 400 mg t.i.d. , which was continued for two days .
The patient was discharged to home on Amiodarone 200 mg daily on 12/29/96 .
An electrocardiogram showed no evidence of QT prolongation prior to discharge , and pulmonary function tests will be performed before the patient goes home today .
The patient will follow up with Dr. Ther Ludzjesc at Shiekeu Hospital Medical Centers in Connecticut .
In addition , she will return to this hospital in early February for repeat attempt at electrical cardioversion on Amiodarone .
She will continue her Coumadin until then and arrangements for her readmission can be made through Dr. Iceca Rhaltkaaispehbreun 's office here .
MEDICATIONS :
Other than the addition of Amiodarone 200 mg daily , will be the same as her admission medications .
STA BODEJOVE , M.D.
DICTATING FOR :
ICECA RHALTKAAISPEHBREUN , M.D.
cc :
Dr. Ther Ludzjesc Director , Section of Cardiology Shiekeu Hospital Medical Centers NC
TR :
sip
DD :
12/29/96
TD :
12/29/96 10:03 A
cc :
ICECA RHALTKAAISPEHBREUN , M.D.
