ELECTROPHYSIOLOGY CONSULT

DATE: 

CC:

HPI: 

PAST MEDICAL HISTORY:

MEDICATIONS:

ALLERGIES:  Patient has answered NKA

FAMILY HISTORY:
SCD:

SOCIAL HISTORY:
TOB:
EToH:
Drugs:

REVIEW OF SYSTEMS:
GENERAL: Denies fever/chills, change in weight
HEAD: Denies dizziness/vertigo, syncope, head trauma.
EYES: Denies any recent change in vision
EAR: Denies change in hearing
NOSE: Denies epistaxis, congestion, rhinorrhea, sinusitis.
MOUTH/THROAT: Denies ulcers
NECK: Denies any pain, stiffness, swelling, masses, thyroid problems.
RESPIRATORY: Denies worsened cough, wheezing/asthma, productive sputum
CARDIO: Denies any chest pain, orthopnea, PND, palpitations, history of
murmurs, edema, claudication
GI: Denies anorexia, weight loss, hematemesis,abdominal pain, change in
bowel habits, hematochezia, bloody stool, melena.
GU: Denies dysuria
MUSCULOSKELETAL: Denies joint pain, stiffness, swelling, heat, deformity,
back pain, bone pain, or myalgia.
SKIN: Denies changes.
NEURO: Denies paralysis, seizures, tremors.
PSYCH: Denies change in mentation or behavior.
HEME/LYMPH:  Denies anemia, easy bruising, bleeding or lymphadenopathy.

PHYSICAL EXAM:
General:  Normal appearance, normally groomed, normal developed male.
The patient was alert and oriented x 3.
Head:  The head exam revealed the patient to be normocephalic,  atraumatic.
Eyes:  The eye exam reviewed that extra-ocular movements were intact and that
the conjunctivae and lids were grossly normal. PEERLA.
ENT:  The oral mucosa was normal in appearance with no obvious cyanosis or
pallor noted.  Oropharynx is without lesions. The nares are patent.  Dentition
is fair.
Neck:  Supple.  Trachea is midline.  No JVD.  Carotid upstrokes were brisk.
No bruits.  No thyromegaly or masses.
Chest:  Lungs were clear to auscultation bilaterally.  Breathing is unlabored.
Normal respiratory excursion.
CV:  Normal rate with a regular rhythm.  S1 was normal, S2 was normal.
Abd:  Bowel sounds were present.  Soft.  Non-tender, non-distended.
Ext:  No clubbing, cyanosis, or edema noted.  Pulses were palpable, including
dorsalis pedis.  Feet was not examined as part of this exam.
Neuro:  No focal neuro deficits noted.   Appropriate muscle strength and tone.
Psychiatric:  Normal and appropriate affect.
 

IMPRESSION:

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***********CONSENT FOR DEVICE*******************

A total of > 45 minutes was spent directly with the patient in the office
during this visit.  More than half of the time during this visit was spent
counseling the patient, reviewing the pathophysiology with him, and explaining
treatment and options.  I drew pictures and diagrams to help illustrate their
underlying pathophysiology and gave it to the patient.

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, pneumothorax, perforation of vessels or heart,
pericardial effusion, tamponade requiring intervention or surgery, unstable
heart rhythm, device malfunction or recall, stroke, myocardial infarction, and
death. The risks of blood transfusion were discussed, and include fever,
transfusion reaction, and infection. All questions were answered, and the
patient voices understanding.  The patient acknowledged the risks of the
procedure, and still wanted to proceed. 

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Device decision was discussed with the patient and included patient's health goals, preferences and values related to this decision. The patient understands all the risks and benefits of this decision. Patient agrees with the plan which is to:

        * Implant an Subcutaneous ICD, Transvenous ICD, or CRT-D to prevent
          sudden cardiac death
        * Not implant a device at this time to prevent sudden cardiac death

*****************************************************************

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***********GEN CHANGE******************

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, pneumothorax, perforation of vessels or heart,
pericardial effusion, tamponade requiring intervention or surgery, unstable
heart rhythm, device malfunction or recall, stroke, myocardial infarction, and
death. The risks of blood transfusion were discussed, and include fever,
transfusion reaction, and infection. All questions were answered, and the
patient voices understanding.  The patient acknowledged the risks of the
procedure, and still wanted to proceed.
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***********ILR******************************

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, stroke, myocardial infarction, and
death. The risks of blood transfusion were discussed, and include fever,
transfusion reaction, and infection. All questions were answered, and the
patient voices understanding.  The patient acknowledged the risks of the
procedure, and still wanted to proceed. 

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***CONSENT FOR ATRIAL FLUTTER ABLATION***

A total of > 45 minutes was spent directly with the patient in the office during
this visit.  More than half of the time during this visit was spent counseling
the patient, reviewing the pathophysiology of atrial fibrillation with him, and
explaining treatment and options.  I drew pictures and diagrams to help
illustrate their underlying pathophysiology and gave it to the patient. 

Treatment options discussed include:
  (a) Observation
  (b) Medical Therapy
  (c) Ablation

The pros and cons of each approach were thoroughly discussed in
depth with the patient. 

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, perforation of vessels or heart, pericardial
effusion, tamponade requiring intervention or surgery, damage to existing native
conduction system requiring need for permanent pacemaker, unstable heart rhythm,
stroke, myocardial infarction, and death. The risks of blood transfusion were
discussed, and include fever, transfusion reaction, and infection. All questions
were answered, and the patient voices understanding.  The patient acknowledged
the risks of the procedure, and still wanted to proceed.
***************************************************

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**********PVI CONSENT****************

A total of > 45 minutes was spent directly with the patient in the office
during this visit.  More than half of the time during this visit was spent
counseling the patient, reviewing the pathophysiology of atrial fibrillation
with him, and explaining treatment and options.  I drew pictures and diagrams
to help illustrate their underlying pathophysiology and gave it to the
patient. 

Treatment options discussed include:
        (a) Observation
        (b) Medical Therapy
        (c) Ablation (PVI)

The pros and cons of each approach were thoroughly discussed in depth with the
patient. 

The risks and benefits of the procedure were explained to the patient in full,
and in simple terms.  The risks of the procedure include, but are not limited
to: pain, bleeding, infection, damage to dentition and/or oropharynx,
esophageal dissection, pneumothorax, perforation of vessels or heart,
pericardial effusion, tamponade requiring intervention or surgery, unstable
heart rhythm, stroke, pulmonary vein stenosis, myocardial infarction, and
death. The risks of blood transfusion were discussed, and include fever,
transfusion reaction, and infection. All questions were answered, and the
patient voices understanding. The patient acknowledged the risks of the
procedure, and still wanted to proceed.
***************************************************

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Total visit time 55 minutes

Elements contributing to total time include:

        -Time personally spent with the patient
        -Obtaining and/or reviewing separately obtained history
        -Performing a medically appropriate examination and or evaluation
        -Counseling and educating the patient/family caregiver
        -Ordering medications, tests, or procedure
        -Referring to and communicating with other healthcare professionals
        -Documenting clinical information in the electronic or other health
        record
        -Independently interpreting results and communicating results to the
        patient/family/caregiver
        -Care coordination