108 lines
5.8 KiB
Mathematica
108 lines
5.8 KiB
Mathematica
DVBCWHE1 ;ALB/JFP HEART WKS TEXT - 1 ; 12 FEB 1998
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;;2.7;AMIE;**16**;Apr 10, 1995
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TXT ;
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;;A. Review of Medical Records:
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;;
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;;B. Medical History (Subjective Complaints):
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;; Comment on:
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;; 1. Past history - describe onset of disorder and frequency of
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;; cardiac symptoms, including angina, dyspnea, fatigue,
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;; dizziness, and syncope. Record dates and severity of
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;; episodes of acute cardiac illness, including myocardial
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;; infarction, congestive heart failure, and acute rheumatic
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;; heart disease. Describe all cardiac surgery, including
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;; coronary artery bypass, valvular surgery, cardiac transplant,
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;; and angioplasty.
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;; 2. Current treatment - type, dosage, response, and side effects.
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;; 3. With the exceptions given below, examinations for valvular
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;; heart disease, endocarditis, pericarditis, pericardial
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;; adhesions, syphilitic heart disease, arteriosclerotic heart
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;; disease, myocardial infarction, hypertensive heart disease,
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;; heart valve replacement, coronary bypass sugery, cardiac
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;; transplanation, and cardiomyopathy, require the examiner to
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;; provide the METs level, determine by exercise testing, at
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;; which symptoms of dyspnea, fatigue, angina, dizziness, or
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;; syncope result.
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;; 4. Exercise testing is not required for the above listed
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;; conditions in the following circumstances:
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;; a. If exercise testing is medically contraindicated:
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;; 1) In that case, provide the medical reason exercise
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;; testing cannot be conducted, and
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;; 2) Provide an estimate of the level of activity
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;; (expressed in METs and supported by specific
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;; examples, such as slow stair climbing, or shoveling
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;; snow) that results in dyspnea, fatigue, angina,
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;; dizziness, or syncope.
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;; b. If left ventricular dysfunction is present, and the
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;; ejection fraction is 50 percent or less.
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;; c. If there is chronic congestive heart failure or there has
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;; been more than one episode of acute congestive heart
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;; failure in the past year.
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;; d. With valvular heart disease - during active infection
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;; with valvular heart damage and for three months following
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;; cessation of therapy for the active infection.
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;; e. With endocarditis - for three months following cessation
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;; of therapy for active infection with cardiac involvement.
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;; f. With pericarditis - for three months following cessation
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;; of therapy for active infection with cardiac involvement.
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;; g. With myocardial infarction - for three months following
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;; myocardial infarction.
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;; h. With valve replacement - for six months following date of
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;; hospital admission for valve replacement.
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;; i. With coronary bypass surgery - for three months following
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;; hospital admission for surgery.
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;; j. For cardiac transplantation - for indefinite period from
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;; date of hospital admission for cardiac transplantation.
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;; k. If an exercise test has been done within the past year,
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;; the results are of record, and there is no indication
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;; that there has been a change in the cardiac status of the
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;; veteran since.
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;; 5. For hyperthyroid heart disease, if atrial fibrillation is
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;; present, use arrhythmia worksheet. Also use endocrine
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;; worksheet if examining for hyperthyroidism.
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;; 6. Describe the effects of the condition on the veteran's usual
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;; occupation and daily activities.
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;; 7. Even when special examinations and tests (e.g., exercise
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;; testing) are not required under the worksheet guidelines, they
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;; may be requested or conducted at the discretion of the
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;; examiner, when the examiner believes that the available
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;; information does not fully reflect the severity of the
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;; veteran's cardiovascular disability.
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;;
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;;C. Physical Examination (Objective Findings):
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;; Address each of the following and fully describe current findings:
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;; 1. Heart size and method of determination, heart rhythm and rate,
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;; heart sounds, blood pressure.
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;; 2. Evidence of congestive heart failure - rales, edema, liver
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;; enlargement, etc.
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;;
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;;D. Diagnostic and Clinical Tests:
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;; 1. Chest X-ray, EKG, exercise stress test, echocardiogram,
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;; Holter monitor, thallium study, angiography, etc., as
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;; appropriate, and as required or indicated.
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;; 2. Include results of all diagnostic and clinical tests
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;; conducted in the examination report, including status of left
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;; ventricular function, if measured.
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;; 3. Valvular heart disease and endocarditis require documentation
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;; of diagnosis by physical findings and either echocardiogram,
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;; Doppler echocardiogram, or cardiac catheterization, if not
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;; already of record.
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;; 4. Other types of heart disease must be documented by appropriate
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;; objective diagnostic tests.
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;;
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;;E. Diagnosis and Opinion:
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;; 1. Type of heart disease and etiology, if known.
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;; 2. Type of surgery, if any, and results.
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;; 3. If the veteran is service-connected for rheumatic heart
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;; disease and later develops non-service-connected
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;; arteriosclerotic heart disease, state, if possible, which
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;; cardiac findings can be attributed to each condition. If it
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;; is not possible to separate the signs and symptoms of one
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;; from the other, so state, and explain.
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;;
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;;
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;;Signature: Date:
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;;END
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