Document Type: Cardiology General IP Consultation   Document Subject: Cardiology Consult Note   Performed By: MD on June 28, 2021 10:21   Verified By:  MD on June 28, 2021 12:36   Encounter Info: Hospital, Inpatient, 06/22/21 - 06/29/21    * Final Report *      Reason for Consultation  Atrial flutter  Referral Source  Hospitalist  History of Present Illness/Subjective     The patient was hospitalized with abdominal pain.  He was noted to have abdominal abscess due to diverticulitis.  He had urgent surgical intervention and now has a colostomy in place.  He is on antibiotics.  His postop recovery has been satisfactory.  He was however noted to have atrial flutter with rapid ventricular response.  I was consulted to be involved in his care  He was given intravenous medication and now is on oral Cardizem.  His heart rate control remains suboptimal  He denies any chest pain  He denies any awareness of the irregular heartbeat  He denies any dizziness or lightheadedness or passing out spells  He denies any swelling in his extremities at baseline with since the surgery and with IV fluids he said that his legs are puffy.  He denies any pain in his calf muscles.  He denies any prior history of atrial flutter or fibrillation.  Review of Systems     Constitutional:  No fevers,  no chills,  no sweats Eyes:  No changes in vision Ears, Nose, Mouth, Throat:  No ear pain,  no nasal congestion,  no sore throat Respiratory:  No shortness of breath,  no cough,  no wheeze Cardiovascular:  No chest pain,  no palpitations,  + edema Gastrointestinal:  + Abdominal pain,  no nausea,  no vomiting,  no diarrhea,  no constipation Genitourinary:  No frequency,  no urgency,  no dysuria,  no hematuria Hematologic/Lymphatic:  No bruising,  no enlarged lymph nodes Allergic/Immunologic:  No hives Endocrine:  No cold intolerance,  no heat intolerance,  no polyuria,  no polydipsia Musculoskeletal:  No arthralgia,  no myalgia Skin:  No rash,  no pruritus Neurological:  No headache,  no focal weakness,  no numbness Psychiatric:  No anxiety,  no depression     Physical Exam/Objective  Vitals & Measurements last 24 hours  Vital Signs (most recent and range for last 24 hours)  Temp (CEL) 36.6 (36.6-37)  Temp (FAHR) 97.9 (97.9-98.6), BP 115/69 (115-123)/(60-69), HR 122 (62-122), RR 18 (16-18), O2Sat 97 (84-97) Neurologic (most recent and range for last 24 hours)  GCS 15(15-15)     Patient Weight  Current Daily Weight:    106.5 kg    06/28/21  Previous Daily Weight:    107.8 kg    06/27/21  Difference from Previous:    -1.300000 kg  BMI:    34.4    06/22/21    Obese (BMI 30-39.9) Patient Height  Current Height:    177.8 cm    06/28/21        Awake  In no distress  Vital signs reveal a heart rate varying between 80 and 120 bpm  It is irregular consistent with atrial flutter/fibrillation  No JVD  I cannot appreciate carotid bruits  Neck is supple  There is no cervical lymphadenopathy  Chest is clear to auscultation anteriorly and posteriorly  Heart sounds S1-S2 audible no added sound no murmurs  Abdomen benign.  Left colostomy in place  Extremities reveal 1+ edema.  No clinical evidence of DVT  Assessment/Plan       1. Perforated diverticulum       2. Intra-abdominal abscess       3. Atrial flutter       4. Tachycardia       5. HTN (hypertension)       6. High cholesterol       7. Obstructive sleep apnea (adult) (pediatric)      8. Normocytic anemia       EKG reveals atrial flutter which is a new diagnosis for the patient  Rate is still elevated especially with exertion.  We will increase the dose of his calcium channel blocker  Beta-blocker can be added if needed  Anticoagulation would be recommended.  At this time we will check with the surgical team and if they are okay with starting anticoagulation we will put him on Eliquis twice daily.  I will leave him in atrial flutter at this time since he anticipates another surgery.  Once his second surgery i.e. reversal of colostomy is done, if he is still in atrial flutter we can consider antiarrhythmic medication/cardioversion.  I had a detailed discussion with the patient who shows good understanding.  I will see him in the office in follow-up to discuss these options further.  I appreciate the opportunity of being involved in the patient's care.  Thank you    Document Type: Cardiology Gen IP Progress Note   Document Subject: Cardiology Progress Note   Performed By: MD on June 29, 2021 10:49   Verified By: MD on June 29, 2021 11:06   Encounter Info: Hospital, Inpatient, 06/22/21 - 06/29/21    * Final Report *           History of Present Illness/Subjective      Feels much better.  Denies any cardiac symptoms  Denies any abdominal symptoms  He says that he feels like he is ready for discharge to nursing home  Denies any chest pain  Denies any palpitations or awareness of irregular heart rhythm  Tolerating anticoagulation well  Review of Systems     Constitutional:  No fevers,  no chills,  no sweats Eyes:  No changes in vision Ears, Nose, Mouth, Throat:  No ear pain,  no nasal congestion,  no sore throat Respiratory:  No shortness of breath,  no cough,  no wheeze Cardiovascular:  No chest pain,  no palpitations,  no edema Gastrointestinal:  No abdominal pain,  no nausea,  no vomiting,  no diarrhea,  no constipation Genitourinary:  No frequency,  no urgency,  no dysuria,  no hematuria Hematologic/Lymphatic:  No bruising,  no enlarged lymph nodes Allergic/Immunologic:  No hives Endocrine:  No cold intolerance,  no heat intolerance,  no polyuria,  no polydipsia Musculoskeletal:  No arthralgia,  no myalgia Skin:  No rash,  no pruritus Neurological:  No headache,  no focal weakness,  no numbness Psychiatric:  No anxiety,  no depression  Physical Exam/Objective  Vitals & Measurements last 24 hours  Vital Signs (most recent and range for last 24 hours)  Temp (CEL) 36.3 (36.3-37.2)  Temp (FAHR) 97.3 (97.3-99.0), BP 121/63 (110-121)/(58-68), HR 81 (71-84), RR 16 (14-20), O2Sat 92 (92-92) Neurologic (most recent and range for last 24 hours)  GCS 15(15-15)     Patient Weight  Current Daily Weight:    104.2 kg    06/29/21  Previous Daily Weight:    106.5 kg    06/28/21  Difference from Previous:    -2.300000 kg  BMI:    34.4    06/22/21    Obese (BMI 30-39.9) Patient Height  Current Height:    177.8 cm    06/29/21         Awake  In no distress  Vital signs at this time is stable  Heart rate is well controlled  Chest is clear to auscultation