Kent Clark, MD
December 25, 2112
The patient denies any palpitations, chest pain, and dizziness. His dizzy on exertion appears to be better. In physical exam, his blood pressure was120/60. His heart rate was 82 beats per minute. His weight is 141 pounds.
His heart was at regular rate and rhythm. There is no gallop or murmur. Lungs are clear to auscultation bilaterally, although air entry is reduced. There is no peripheral edema. Interrogation of his implantable cardioverter-defibrillator (ICD), which is a single-chamber St.Jude device, showed a total of 49 episodes of supraventricular tachycardia. These are either atrial fibrillation, or atrial tachycardia. 48 of 49 episodes were between 150 to 190 beats per minute, which is within monitor only zone of the ICD. None of these episodes lasted more then one minute. He had one episode of supraventricular tachycardia, which was more then 190 beats per minute. This episode was terminated by antitachycardia pacing. He was asymptomatic during these tachycardias. Interrogation of the lead showed an increase in the right ventricular pacing threshold to 4.5 to ? .5 milla seconds. Lead impedance is 428 ? . ? are 10.8 mil. He is paced in the ventricle less then 1 % of the time.
In view of his frequent supraventricular tachycardia episode, I started him on Lexapro 180 mg p.o. daily. I also warned him that Lexapro might cause constipation.
I will see him in follow-up in one month. If he continues to have frequent episodes of supraventricular tachycardia, I will start him on comedone.
Kent Clark, MD
D: December 25, 2112
T: January 08, 2113
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