Clinic letter GT

Dear Dr. Eleanor Vance, Thank you very much for referring Mrs. Evelyn Reed to my Arrhythmia Clinic. It was a pleasure to review Mrs. Evelyn Reed once again in my Arrhythmia Clinic. As you know, Mrs. Evelyn Reed is a 68-year-old female retired teacher with the following past medical history: HISTORY OF PRESENTING ILLNESS: Mrs. Reed presents today with a history of palpitations and occasional chest discomfort, which she describes as a pressure-like sensation. These episodes have been occurring for the past six months, with increasing frequency over the last month. She denies any associated shortness of breath, dizziness, or syncope. She reports that the palpitations often occur at rest and are not related to any specific triggers. CARDIAC RELATED HISTORY: Mrs. Reed has a history of paroxysmal atrial fibrillation, diagnosed two years ago. She underwent successful pulmonary vein isolation (PVI) ablation one year ago. OTHER PAST MEDICAL HISTORY: Hypertension, well-controlled with medication. CARDIAC RISK FACTORS: Hypertension, family history of coronary artery disease. SOCIAL HISTORY: Mrs. Reed is a non-smoker and drinks alcohol occasionally. She is widowed and lives alone. She maintains a regular exercise routine, including walking and swimming. KNOWN ALLERGIES/INTOLERANCES: No known drug allergies. ACTIVE CARDIAC MEDICATIONS: Bisoprolol 2.5mg once daily, Apixaban 5mg twice daily. OTHER RELEVANT ACTIVE MEDICATIONS: Lisinopril 10mg once daily. FAMILY HISTORY: Father died of a myocardial infarction at age 72. Mother has hypertension. REVIEW OF SYSTEMS: Mrs. Reed denies any recent fever, chills, or weight changes. She reports occasional mild fatigue. No chest pain, shortness of breath, or palpitations today. PHYSICAL EXAMINATION: Blood pressure 130/80 mmHg, heart rate 72 bpm and regular. Cardiac auscultation reveals a regular rhythm, no murmurs, rubs, or gallops. Lungs are clear to auscultation bilaterally. No peripheral oedema. INVESTIGATIONS: ECG: Normal sinus rhythm. Echocardiogram: Mild left atrial enlargement. No significant valvular abnormalities. 24-hour Holter monitor: Occasional premature atrial contractions, no atrial fibrillation episodes detected. ASSESSMENT AND PLAN: Following a detailed discussion, we have decided upon the following management plan: 1. Recurrent Palpitations: The patient reports occasional palpitations. The Holter monitor did not capture any atrial fibrillation episodes. We will continue with the current medication regimen of Bisoprolol and Apixaban. We will also schedule a repeat 24-hour Holter monitor in six months to monitor for any recurrence of atrial fibrillation. 2. Hypertension: The patient's blood pressure is well-controlled on Lisinopril. We will continue with the current medication and monitor blood pressure at follow-up appointments. FOLLOW-UP: Follow-up appointment in three months to review the results of the repeat Holter monitor and assess for any changes in symptoms. Thank you very much for involving me in the care of Mrs. Evelyn Reed. Please do not hesitate to contact me should you have any questions. Yours sincerely, Dr. Thomas Kelly, MD Consultant Cardiologist