source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWAM1.m@ 1389

DVBCWAM1 ;ALB/JFP ARRHYTHMIAS WKS TEXT - 1 ; 11 FEB 1997
 ;;2.7;AMIE;**16**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;A.  Review of Medical Records:
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    1.  Type of arrhythmia, onset of disorder, frequency and
 ;;        duration of attacks.  Attacks confirmed by EKG or Holter
 ;;        monitor?.
 ;;    2.  Pacemaker present?  If so, when was it inserted,
 ;;        effectiveness, side effects?
 ;;    3.  Other treatment?  If so, type, effectiveness, side effects?
 ;;    4.  For sustained ventricular arrhythmias, atrioventricular
 ;;        block, and implantable cardiac pacemakers (if ventricular
 ;;        arrhythmia or atrioventricular block was the reason for the
 ;;        pacemaker), the examiner must provide the METs level,
 ;;        determined by exercise testing, at which symptoms of dyspnea, 
 ;;        fatigue, angina, dizziness, or syncope result.
 ;;    5.  Exercise testing is not required for the above listed
 ;;        conditions in the following circumstances:
 ;;        a.  If exercise testing is medically contraindicated:
 ;;            1)  In that case, provide the medical reason exercise
 ;;                testing cannot be conducted, and
 ;;            2)  Provide an estimate of the level of activity
 ;;                (expressed in METs and supported by specific
 ;;                examples, such as slow stair climbing, or
 ;;                shoveling snow) that results in dyspnea, fatigue,
 ;;                angina, dizziness, or syncope.
 ;;        b.  For sustained ventricular arrhythmia-from date of
 ;;            hospital admission for initial evaluation and medical
 ;;            therapy for a sustained ventricular arrhythmia or for
 ;;            ventricular aneurysmectomy, and for six months
 ;;            following discharge.
 ;;        c.  With an automatic implantable Cardioverter-Defibrillator
 ;;            (AICD) in place.
 ;;        d.  For two months following hospital admission for
 ;;            implantation or reimplantation of an implantable
 ;;            cardiac pacemaker.
 ;;        e.  If an exercise test has been done within the past year,
 ;;            the results are of record, and there is no indication
 ;;            that there has been a change in the cardiac status of
 ;;            the veteran since.
 ;;    6.   For implantable cardiac pacemakers - if supraventricular
 ;;         arrhythmia was the reason for the pacemaker - describe any
 ;;         attacks of atrial fibrillation or other symptoms.
 ;;    7.   Describe the effects of the condition on the veteran's
 ;;         usual occupation and daily activities.
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe current findings:
 ;;    1.  Heart size and method of determination, heart rate and
 ;;        rhythm, blood pressure.
 ;;    2.  Status of cardiac function - evidence of congestive heart
 ;;        failure.
 ;;    3.  Cardiac arrhythmia - type.  Confirmed by EKG or Holter
 ;;        monitor?
 ;;
 ;;D  Diagnostic and Clinical Tests:
 ;;  
 ;;   1.  EKG.
 ;;   2.  Holter monitor, other tests as indicated.
 ;;   3.  Chest X-ray, exercise stress test, echocardiogram, Holter
 ;;       monitor, thallium study, angiography, etc., as appropriate,
 ;;       and as required or indicated.
 ;;   4.  Include results of all diagnostic and clinical tests
 ;;       conducted in the examination report, including status of
 ;;       left ventricular function, if measured.
 ;;
 ;;E.  Diagnosis:
 ;;  
 ;;
 ;;
 ;;Signature:                                        Date:
 ;;END