Today did not go as planned. This was to be Terry’s last visit with his current cardiologist but Dr B was called to the Cath lab and the next available appointment wasn’t until next year. We were able to get his office notes concerning his last echocardiogram. I am going to share some of it now. It will help all better understand.
-The patient presents for follow-up. He’s had prior complicated cardiovascular history which includes a prior anterior wall myocardial infarction(the widowmaker), left ventrical thrombus(blood clot), cerebrovascular accident(a stroke), cardiac arrest secondary to ventricular fibrillation(the was just after the widowmaker), pulmonary arrest, AICD(the defibrillator) placement with subsequent removal secondary to pocket infection and dehiscence. He presents for follow-up and review of the most recent left ventricular functional assessment.
-Recent echocardiogram was reviewed. His ejection fraction remains 30-35%. He has moderate pulmonary hypertension. Ejection fraction has not improved with medical therapy due to severity of condition.
History of cardiac arrest
Abnormal thallium stress test
Hot flashes not due to menopause
History of TIA(transient ischemic attack) and stroke
Left ventricular thrombus
Systolic congestive heart failure with reduced left ventricular function, NYHA class 2
-I discussed the echo findings. With present ejection fraction less than 35%, I recommended proceeding with repeat AICD. Consultation will be obtained. We will check the logistics of his insurance coverage but my recommendation will remain the same, he is at increased life-threatening dysrhythmia risk and AICD should be placed.
His insurance will not cover the AICD placement at that hospital. It would cost $275,000, if we pay for it. This is why he is changing doctors. He has to go where his insurance is accepted.
I hope this will help everyone better understand what is going on with Terry’s health. I tried to add description when I could by using ().