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1DVBCWAM1 ;ALB/JFP ARRHYTHMIAS WKS TEXT - 1 ; 11 FEB 1997
2 ;;2.7;AMIE;**16**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;A. Review of Medical Records:
7 ;;
8 ;;B. Medical History (Subjective Complaints):
9 ;;
10 ;; 1. Type of arrhythmia, onset of disorder, frequency and
11 ;; duration of attacks. Attacks confirmed by EKG or Holter
12 ;; monitor?.
13 ;; 2. Pacemaker present? If so, when was it inserted,
14 ;; effectiveness, side effects?
15 ;; 3. Other treatment? If so, type, effectiveness, side effects?
16 ;; 4. For sustained ventricular arrhythmias, atrioventricular
17 ;; block, and implantable cardiac pacemakers (if ventricular
18 ;; arrhythmia or atrioventricular block was the reason for the
19 ;; pacemaker), the examiner must provide the METs level,
20 ;; determined by exercise testing, at which symptoms of dyspnea,
21 ;; fatigue, angina, dizziness, or syncope result.
22 ;; 5. Exercise testing is not required for the above listed
23 ;; conditions in the following circumstances:
24 ;; a. If exercise testing is medically contraindicated:
25 ;; 1) In that case, provide the medical reason exercise
26 ;; testing cannot be conducted, and
27 ;; 2) Provide an estimate of the level of activity
28 ;; (expressed in METs and supported by specific
29 ;; examples, such as slow stair climbing, or
30 ;; shoveling snow) that results in dyspnea, fatigue,
31 ;; angina, dizziness, or syncope.
32 ;; b. For sustained ventricular arrhythmia-from date of
33 ;; hospital admission for initial evaluation and medical
34 ;; therapy for a sustained ventricular arrhythmia or for
35 ;; ventricular aneurysmectomy, and for six months
36 ;; following discharge.
37 ;; c. With an automatic implantable Cardioverter-Defibrillator
38 ;; (AICD) in place.
39 ;; d. For two months following hospital admission for
40 ;; implantation or reimplantation of an implantable
41 ;; cardiac pacemaker.
42 ;; e. If an exercise test has been done within the past year,
43 ;; the results are of record, and there is no indication
44 ;; that there has been a change in the cardiac status of
45 ;; the veteran since.
46 ;; 6. For implantable cardiac pacemakers - if supraventricular
47 ;; arrhythmia was the reason for the pacemaker - describe any
48 ;; attacks of atrial fibrillation or other symptoms.
49 ;; 7. Describe the effects of the condition on the veteran's
50 ;; usual occupation and daily activities.
51 ;;
52 ;;C. Physical Examination (Objective Findings):
53 ;;
54 ;; Address each of the following and fully describe current findings:
55 ;; 1. Heart size and method of determination, heart rate and
56 ;; rhythm, blood pressure.
57 ;; 2. Status of cardiac function - evidence of congestive heart
58 ;; failure.
59 ;; 3. Cardiac arrhythmia - type. Confirmed by EKG or Holter
60 ;; monitor?
61 ;;
62 ;;D Diagnostic and Clinical Tests:
63 ;;
64 ;; 1. EKG.
65 ;; 2. Holter monitor, other tests as indicated.
66 ;; 3. Chest X-ray, exercise stress test, echocardiogram, Holter
67 ;; monitor, thallium study, angiography, etc., as appropriate,
68 ;; and as required or indicated.
69 ;; 4. Include results of all diagnostic and clinical tests
70 ;; conducted in the examination report, including status of
71 ;; left ventricular function, if measured.
72 ;;
73 ;;E. Diagnosis:
74 ;;
75 ;;
76 ;;
77 ;;Signature: Date:
78 ;;END
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