[doctor] patient's name is diana scott . date of birth , 12/8/1920 . the date of service is 7/9/2021 . this is a new patient note .
[doctor] good afternoon . how are you today ?
[patient] i'm good , thank you .
[doctor] good . well , what brings you in to see me today ?
[patient] well , my doctor says that i have a heart murmur .
[doctor] okay .
[patient] so i do n't know how big a heart murmur i have , or really even what it is .
[doctor] okay . so how long have you had that for ? do you have any idea , or is that completely new as far as you know ?
[patient] yeah , she said it's a new worrisome heart murmur . so of course , i'm worried as well .
[doctor] got it . okay . and are you having any symptoms at all ?
[patient] i do n't think so . i do n't know what symptoms i should be having .
[doctor] okay . well , so you are 100 , so we ca n't really get around that one . so i expect that you probably do n't move quite as fast as maybe you used to ?
[patient] no , i definitely do n't .
[doctor] okay . and do you notice that you have any chest pain or f- feel shortness of breath ?
[patient] no , i do n't have any chest pain . um , my problem is i have severe pains in my legs , and so she had me going for a chest x-ray , and that was just last week .
[doctor] okay .
[patient] and so i started taking pain pills for my legs .
[doctor] okay , got it , for the legs . and do you feel short of breath at all ?
[patient] if i walk too fast or too long , or if i tried to drink a whole glass of water without stopping , then yeah , i do get short of breath that way .
[doctor] okay . and how far can you walk before you feel short of breath or sort of overly fatigued ?
[patient] well , i do have a walker now , so i do n't know . maybe when i walk to the end of the driveway or i walk around the culdesac .
[doctor] got it . all right .
[patient] so it is n't that bothersome to me at all . um , maybe more if i try to overdo it .
[doctor] okay .
[patient] then i , um , i get short of breath if i do overdo it though .
[doctor] okay , got it . and so how different would you say , um , that the symptoms are now compared to like six months ago or a year ago ?
[patient] i would say probably 70 to 80 % from about six months ago . before that i did n't notice anything at all .
[doctor] okay . so do you feel like it's mainly the leg pain that seems to limit you ?
[patient] my legs have been severe for about a month now .
[doctor] okay . and how about , do you feel lightheaded or dizzy at all ?
[patient] yeah . so i do take a pill for that when it does get bad .
[doctor] okay .
[patient] yeah , and i do n't take it every day , only when i do feel dizzy .
[doctor] okay . and so how about any passing out at all ?
[patient] no .
[doctor] okay , good . and how about irregular heartbeats ? do you ever feel like your heart is going too fast or like it skips a beat ?
[patient] i do n't notice it at all .
[doctor] okay , great . and how about any swelling in the legs at all ?
[patient] yeah , my ankles swell .
[doctor] okay . and how long has this been going on ?
[patient] um , i would say for probably six months . but it goes up and down , and sometimes it's worse than other times .
[doctor] okay . and how about any recent weight gain or anything else like that ?
[patient] um , i lost a little bit of weight , but i still weigh a 120 pounds , but i normally weigh about 130 pounds .
[doctor] mm-hmm . okay .
[patient] um , but that's been going down gradually for about a year .
[doctor] okay . and then how about any fevers , chills or anything else that's , that's going on that you can think of ?
[patient] no .
[doctor] good . so mainly it sounds like you came in , um , mostly because of the murmur . is that right ? and sort of just kind of seeing what things look like ?
[patient] yeah , that and i feel overly tired because i take all that medication .
[doctor] okay . and so fatigue as well . and have you ever had any testing of your heart done ?
[patient] i'm not really sure .
[doctor] okay . it does look like you've had a decent number of sh- , uh , surgeries here , ?
[patient] yeah , you name it .
[doctor] all right . well , i wo n't make you repeat them since i do have a good record . um , but just give me just a second and i'm going to enter the ones we need , okay ? all right . got them . and then , are you taking all the medicines that you went through with madison ?
[patient] yes .
[doctor] okay , good . and looking at your family history , it looks like maybe your brother had a heart attack . is that correct ?
[patient] it was actually my son , not my brother .
[doctor] okay , i'll make that adjustment .
[patient] um , but my brother did have a stroke . but that was because he had gotten sugar diabetes , and my eldest sister did have a heart problem as well .
[doctor] okay , i see .
[patient] yeah , so heart problems kinda run in the family .
[doctor] okay . all right . well , it looks like also that you never smoked . that's excellent . and then no allergies to medicines that you know of , is that correct ?
[patient] correct .
[doctor] all right . well , let's do a quick exam .
[patient] all right . sounds good .
[doctor] all right . well , for physical exam , please use the regular template . all right , please just breathe normally . great . and now take a few deep breaths for me . all right . do you feel okay ? are you feeling any dizziness or anything ?
[patient] no , i feel fine .
[doctor] okay , great . all right . well , that is it for the exam .
[patient] okay .
[doctor] all right . so what i'm thinking is , let's go ahead and schedule you for an echocardiogram . it's a very common test and it just takes a picture of your heart . and it'll let me see how well your heart is actually working .
[patient] okay .
[doctor] and i can order that for today . um , do you have time to complete that ? it should n't take too long .
[patient] yes , that's fine . i have time .
[doctor] okay , great . so we will complete that today , um , to assess your overall cardiac structure and function , as well as , uh , the valve view of where diseased .
[patient] okay .
[doctor] and some hospital outcomes and what we might suggest to fix that out , i'll go over that . so one possible suspicion i'm having is it's called , um , aortic stenosis , and that just means that one of your main valves of your heart has narrowed a bit and the valve does n't really open , um , quite fully . and this could just reduce or block the blood flow from your heart into the main artery of your body , and that's called the aorta , into the rest of your body .
[patient] okay .
[doctor] and if this is severe , then we might wan na perform a procedure called the transcatheter aortic valve replacement , or we just call it tavr . and it is a minimally invasive procedure to replace the valve .
[patient] well , i would have to think about that . i'm not too sure i'd wan na do that , given my age of all .
[doctor] yeah , sure , no problem . and we do n't have to make any decisions today , just , you know , wanted to go over a couple of these things . um , but sometimes we can also perform a surgical aortic valve replacement , or it's called an savr . but really , because of your age and medical history , um , unfortunately , that would n't be a good option for you .
[patient] i see . okay . well , i guess we'll see , um , what you see from , from the , um , test .
[doctor] yeah , agreed . okay . and , um , so couple other things real quick . so it looked like your blood pressure looked really good today . so we're not going to change your amlodipine or lisinopril . so just continue taking those as you are currently .
[patient] okay , good .
[doctor] and then , it also looks like you're taking about 20 milligrams of simvastatin for your lipids . and i will pr- , um , defer to your pcp . however , given you are having leg pain in both your legs , and given your age and no history of coronary artery d- , artery disease , it is possible that you might be able to stop your statin .
[patient] really ?
[doctor] yeah , um , possibly . he would have to evaluate you , but it is certainly something to discuss with him . so i will send over the results of the echocardiogram and also my recommendations and then you guys can talk about the statin .
[patient] okay , that sounds great . thank you .
[doctor] you're welcome . and then , um , lastly , your hyperthyroidism , uh , i see you're taking levothyroxine . and again , no change here and you can just keep taking that as you have them .
[patient] okay , i will .
[doctor] all right . so we will see you back here in about three or four weeks to discuss the results and your next steps . um , and we'll , uh , take care of your echocardiogram today . um , any questions ?
[patient] not that i can think of . thank you so much . and i think it looks good .
[doctor] okay , awesome . all right . well , have a good rest of your day , and we'll see you soon .
[doctor] for physical exam , constitutional elderly otherwise no acute distress . cardiovascular normal s1 and s2 is preserved with a normal rate and regular rhythm . there is a 4/6 systolic murmur at the right upper sternal border with , uhm , mild radiation to the carotids . neurologic gait is normal for age .
[doctor] for assessment and plan , probably one cardiac murmur . diana has a 4/6 systolic murmur at the upper right sternal border with mild radiation to the carotids . this is most likely representative of aortic stenosis , for symptoms could be due to severe aortic , aortic stenosis . however , her s2 is relatively preserved , which would be more consistent with , consistent with moderate . some of her outside records do note diastolic dysfunction , so it is possible she , she did have an echocardiogram at some point in the past . she does not appear significantly volume overloaded today .
[doctor] her next problem is pvcs . her referral mentioned tachycardia . uh , her ekg today shows sinus rhythm with frequent pvcs , as well as an anterior septum infarct pattern . she does not have any significant palpitations and we will check an echocardiogram to assess overa- overall cardiac structure and function . depending on results as well as the severity of her aortic stenosis , we will need to consider an ischemic evaluation , or further , possibly a heart mon- monitor to assess overall burden of the pvcs . at this point , she's asymptomatic , so we will start with the echocardiogram only .
[doctor] her next problem , hypolipidemia , is managed by her pcp . due to bilateral leg pain over the last month , considered tavr evaluation following echocardiogram . statin could be indicated .
[doctor] and next problem , lightheadedness , dizziness . she is on meclizine for this . it is possible that some of her lightheadedness and dizziness is related to the aorta stenosis , and we will do an echocardiogram as noted above . pvcs on her ekg could be contributing , but she does not feel palpitations . we will consider a monitor , but start with the echocardiogram first as noted above . follow up three to four weeks after her echocardiogram is done to discuss results and next steps . end of dictation .

Medical orders:
description: follow up three to four weeks
order_type: followup
description: today echocardiogram cardiac structure
order_type: imaging
reason: most likely representative of aortic stenosis