Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
|
Hi, my name is xx and I will interview you and later examine you
|
Greet |
|
 |
Hi there.
|
|
 |
Can you hear me?
|
Question |
|
Yeah, I can hear you clearly.
|
|
|
Are you in an appropriate environment for a telehealth visit?
|
Question |
|
This is a fine place for us to talk.
|
|
|
Do you understand that this telehealth visit is confidential?
|
Question |
|
Yup, I understand that this visit is private and confidential. [AUDIO COMING SOON]
|
|
|
What brings you here today?
ORDER SHADOW HEALTH HELP HERE |
Question |
|
I’m OK, just here for my regular telehealth follow-up.
|
|
|
When was your last hospital visit?
|
Question |
|
Six months ago I was in the hospital for my heart failure symptoms.
|
|
|
When were you diagnosed with heart failure?
|
Question |
|
I was diagnosed with heart failure . . . two years ago now.
|
|
|
What symptoms do you currently have? (Clarified to Do you know what symptoms are you experiencing?.)
|
Question |
|
I don’t really have any symptoms, just here for my follow-up. I’m doing OK. (Clarified to if I know what my symptoms are.)
|
|
|
Are you using any medications?
|
Question |
|
My regular heart meds are carvedilol, candesartan, spironolactone, and an aspirin. I have some heart meds that I take as needed too — furosemide, a potassium chloride tablets, and nitroglycerin. For my cholesterol I take atorvastatin and some fish oil.
|
|
|
What are the dosages of your medications?
|
Question |
|
We’re going to have to go down the list since I have regular heart medications, as needed heart medications, and cholesterol medications.
|
|
|
What is the dosage of your heart medications?
|
Question |
|
The carvedilol is 12.5 milligrams, the candesartan is 32 milligrams, the spironolactone is 12.5 milligrams, and the aspirin is an 81 mg EC tablet. And then I take some as needed heart failure medications.
|
|
|
What is the dosage of your cholesterol medications?
|
Question |
|
Hm, let’s see. I take the atorvastatin — it’s 40 mg — and the omega-3 fatty acid fish oil, it’s 1000 mg. I take them both everyday.
|
|
|
What is your medical history?
|
Question |
|
That’s a long list, let’s see . . . Well I have heart failure, that’s the big one. And I have coronary artery disease, high blood pressure, high cholesterol, and I had a heart attack a while back.
|
|
|
When were you diagnosed with coronary artery disease?
|
Question |
|
I was diagnosed with it five years ago, at the time of my heart attack.
|
|
|
When were you diagnosed with high blood pressure?
|
Question |
|
I’ve had high blood pressure for some time now. I was diagnosed at 38 but didn’t try to manage it much. It’s better now though.
|
|
|
What do you use for your high blood pressure? (Clarified to How do you control your blood pressure?.)
|
Question |
|
I’m on a few heart medicines, but the carvedilol is the one for blood pressure. (Clarified to how I control my blood pressure.)
|
|
|
Any family history pf heart problems?
|
Question |
|
Yeah, heart issues run in the family. Mom’s alive, but she has high blood pressure and high cholesterol. Dad passed at 75 from a heart thing, not sure what it was, and he also had high blood pressure . . . oh and he had open heart surgery too.
|
|
|
What is your diet like? Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
|
Question |
|
Well I’m on a low-sodium diet and I try to follow it. For breakfast I have oatmeal with some berries. Lunch is usually some soup, I try to do homemade ones, or some pasta with grilled chicken and vegetables. I’ll have a salad sometimes. Dinner is some fish or grilled chicken with some more vegetables, and some brown rice. If I want a snack, it’s air popped, no salt popcorn, or an apple with no salt almond butter. It’s not very exciting, but it’s what I need to do.
|
|
|
Great. healthy diet is good for your health
|
Educate |
|
OK, thanks.
|
|
|
Do you exercise?
|
Question |
|
Yeah, I exercise regularly. I do tai chi.
|
|
|
Great. Exercise is good for your health Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
|
Educate |
|
Got it. Thanks.
|
|
|
Any allergies?
|
Question |
|
No, I don’t have allergies.
|
|
|
Are your immunizations current?
|
Question |
|
I believe I’m up to date.
|
|
|
Have you missed any medications? (Clarified to Do you miss doses of your medication?.)
|
Question |
|
No. I’m good about taking my medicine. (Clarified to if I miss doses of my medication.)
|
|
|
Great, it is good to take medications as prescribed
|
Educate |
|
Gotcha.
|
|
|
have you ever had a heart attack?
|
Question |
|
Yes, I have had a heart attack.
|
|
|
When did you last have a heart attack?
|
Question |
|
My heart attack was five years ago.
|
|
|
What are the symptoms of your heart attack?
|
Question |
|
The main thing I remember was really intense discomfort in my chest.
|
|
|
Any history of hospitalizations?
|
Question |
|
I’ve had a few hospital stays. Five years ago I had a heart attack and they did surgery. Two years ago I had some issues with my heart and went back in and they diagnosed me with heart failure. Six months ago was the most recent time, my heart again. I wasn’t feeling great, but they took care of me and I was OK.
|
|
|
How have heart problems affected your life? (Clarified to How does your heart failure affect you?.)
|
Question |
|
It doesn’t, really — it’s asymptomatic most of the time. (Clarified to how my heart failure affects me.)
|
|
|
Do you drink?
|
Question |
|
Yeah, I drink some.
|
|
|
How often do you drink?
|
Question |
|
I don’t really drink very often these days, just on special occasions. I used to have one or two beers a night, but I had to cut down after my heart attack. I’ll have that non-alcoholic stuff sometimes, it’s not half bad, but I’d just rather stick with the real thing if I’m going to have a drink.
|
|
|
Too much alcohol consumption is not good for your health
|
Educate |
|
Alright then. Thanks.
|
|
|
Do you smoke
|
Question |
|
I used to smoke.
|
|
|
When did you last smoke?
|
Question |
|
I quit smoking after my heart attack. I still get cravings though so I use the nicotine gum.
|
|
|
Great. Smoking is not good for your health
|
Educate |
|
Ah, I see.
|
|
|
Have you ever had an EKG test?
|
Question |
|
Yeah, when I was hospitalized six months ago for heart failure stuff, they did an EKG and an echocardiogram.
|
|
|
What is your blood pressure number? (Clarified to Do you know your blood pressure number?.)
|
Question |
|
Today it was 155 over 95. A little higher than normal. (Clarified to if I know my blood pressure number.)
|
|
|
Any weight issues? (Clarified to Have you lost weight?.)
|
Question |
|
No, I’ve actually gained some. (Clarified to if I have lost weight.)
|
|
|
Gaining weight will only worsen your heart problems
|
Educate |
|
Got it. Thanks.
|
|
|
How much weight have you gained?
|
Question |
|
About four or five pounds.
|
|
|
Any swelling?
|
Question |
|
Yeah, I have some swelling right now.
|
|
|
Where is the swelling located?
|
Question |
|
In my feet and ankles.
|
|
|
Any chest pain?
|
Question |
|
No, my chest hasn’t been hurting.
|
|
|
Any palpitations?
|
Question |
|
I don’t have any palpitations at all.
|
|
|
What caused our weight gain?
|
Question |
|
I don’t know, really.
|
|
|
Have you been eating more? (Clarified to Is your appetite fine?.)
|
Question |
|
My appetite’s been the same, pretty normal. [AUDIO COMING SOON] (Clarified to if my appetite is okay.)
|
|
|
Do you monitor your heart problems? (Clarified to What heart problems do you have?.) Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
|
Question |
|
I have a little swelling right now, if that counts. If you mean what heart conditions I have — I have coronary artery disease, heart failure, high cholesterol, high blood pressure, and I had a heart attack. (Clarified to what heart problems I have.)
|
|
|
Do you take caffeine?
|
Question |
|
I drink decaf.
|
|
|
How often do you exercise?
|
Question |
|
I do tai chi three times a week.
|
|
|
Any skin problems?
|
Question |
|
No, my skin is normal, same as ever.
|
|
|
Any fatigue?
|
Question |
|
I’m feeling OK — not tired.
|
|
|
What is your occupation?
|
Question |
|
I’m retired now, but I worked as a truck driver for the postal service.
|
|
|
What is your living situation?
|
Question |
|
My home environment is good. I live in a one-story house with my daughter Claire, her husband Mark, and my grandson, Callum.
|
|
|
Any urination issues?
|
Question |
|
No issues with going to the bathroom, but I do wake up needing to pee at night.
|
|
|
Any weakness?
|
Question |
|
I’m no Thor, but I can still open pickle jars when needed.
|
|
|
Any breathing problems?
|
Question |
|
I haven’t had any issues with my breathing.
|
|
|
Are you sexually active?
|
Question |
|
Yeah, things are just fine in the bedroom with my lady, Susan.
|
|
|
move the camera so your ankles are visible on the screen
|
Question |
|
Sure, hold on, let me move this thing.
|
|
|
Inspected left ankle: Edema is present on inspection of bilateral ankles without erythema or streaking
|
Exam Action |
|
Inspected right ankle: Edema is present on inspection of bilateral ankles without erythema or streaking Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
|
Exam Action |
|
move the camera so your ankles are visible on the screen, press your finger into the inner boney part of the ankle and hold for 1-2 seconds.
|
Question |
|
Sure, hold on, let me move this thing.
|
|
|
Palpated right ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation
|
Exam Action |
|
Palpated left ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation
|
Exam Action |
|
Hello. I am going to educate you about your medications
|
Question |
|
Sounds good.
|
|
|
maintain normal activity level, bur discontinue exercise if you experience chest pain
|
Question |
|
That sounds good. I’ll stop exercising and call the cardiologist if I get symptoms.
|
|
|
Adhere to a fluid volume restriction of 1.5 L per day
|
Question |
|
Will do. I am very good about my fluid restrictions.
|
|
|
Avoid drinking alcohol
|
Question |
|
Alright, I’ll lay off the alcohol.
|
|
|
Avoid drinking caffeinated beverages
|
Question |
|
OK, no caffeine, but is decaf fine?
|
|
|
No
|
Question |
|
Sounds good, I’ll be careful even with decaf.
|
|
|
Eat lean meat, whole grains, and fresh fruits and vegetables and season your food with spices instead of salt
|
Question |
|
That’s a smart trick. OK, I’ll do that.
|
|
|
Ask your provider for a referral to a clinical dietitian
|
Question |
|
OK, that’s a good tip.
|
|
|
Adhere to your low-sodium diet, and pay attention to labels to avoid foods high in sodium
|
Question |
|
Sounds good. I’ll avoid those high-sodium foods, but what foods should I look at the labels for again?
|
|
|
All foods
|
Question |
|
Alright, I’ll be careful to read all the labels then.
|
|
|
After consuming a meal high in sodium, watch for signs and symptoms of a worsening condition and take your diuretic as directed.
|
Question |
|
That sounds like a plan . . . but how long should I wait after experiencing symptoms before I take the furosemide and potassium chloride?
|
|
|
30 minutes
|
Question |
|
OK, I’ll watch out for those signs and symptoms carefully.
|
|
|
Test for swelling by performing a pitting edema test
|
Question |
|
I’ll look out for that, then . . . though, how do I know if the swelling is related to my CHF and not something else, like standing for long time?
|
|
|
Watch out for fatigue
|
Question |
|
OK, that’s good to know.
|
|
|
Look out for signs of fluid overload, like weight gain, fatigue during activity
|
Question |
|
I’ll look out for symptoms.
|
|
|
Go to the hospital if your condition worsens Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
|
Question |
|
I definitely will.
|
|
|
Follow up with your cardiologist
|
Question |
|
I’ll call my cardiologist if that happens.
|
|
|
Set a reminder for your medications
|
Question |
|
Alright. I’ll let my girlfriend and my daughter know . . . but if I take the medication as needed, how will I know if I need a reminder?
|
|
|
You girlfriend and daughter can remind you to take your medications
|
Question |
|
Thanks, those are good suggestions.
|
|
|
Take furosemide with the potassium chloride to maintain adequate potassium
|
Question |
|
I’ll do that, then.
|
|
|
Take the furosemide with potassium chloride tablet for edema even if you have minor swelling
|
Question |
|
I will!
|
|
|
Beware of symptoms that indicate worsening condition
|
Question |
|
Sounds good. I’ll keep an eye out for when to take those meds.
|
|
|
Thanks for listening, Goodbye
|
Question |
|
Alright. Thank you for your help. Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
|