Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript

Management of Cardiovascular Conditions Patient

Hello, my name is xx, and I will conduct an interview with you and later perform an examination.
Greet
April 20, 2023, 5:41 PM EDT
Hi there. Can you hear me?
Question
April 20, 2023, 5:41 PM EDT
Yeah, I can hear you clearly. Are you in an appropriate environment for a telehealth visit?
Question
April 20, 2023, 5:42 PM EDT

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This is a fine place for us to talk. Do you understand that this telehealth visit is confidential?

Question
April 20, 2023, 5:43 PM EDT

Yup, I understand that this visit is private and confidential. [AUDIO COMING SOON] What brings you here today?

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Question
April 20, 2023, 5:44 PM EDT

I’m OK, just here for my regular telehealth follow-up. When was your last hospital visit?

Question
April 20, 2023, 5:47 PM EDT

Six months ago, I was in the hospital for my heart failure symptoms. When were you diagnosed with heart failure?

Question
April 20, 2023, 5:48 PM EDT

I was diagnosed with heart failure two years ago now. What symptoms do you currently have?

Question
April 20, 2023, 5:48 PM EDT

I don’t really have any symptoms, just here for my follow-up. I’m doing OK. Are you using any medications?

Question
April 20, 2023, 5:49 PM EDT

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 tablet, and nitroglycerin. For my cholesterol, I take atorvastatin and some fish oil.

Liam Fitzgerald Telehealth Follow Up Sick Visit: Management of Cardiovascular Conditions

Question
April 20, 2023, 5:50 PM EDT

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
April 20, 2023, 5:51 PM EDT

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.

Question
April 20, 2023, 5:53 PM EDT

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 every day. What is your medical history?

Question
April 20, 2023, 5:53 PM EDT

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.

Question
April 20, 2023, 5:55 PM EDT

I was diagnosed with it five years ago, at the time of my heart attack. When were you diagnosed with high blood pressure?

Question
April 20, 2023, 5:55 PM EDT

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?

Question
April 20, 2023, 5:56 PM EDT

I’m on a few heart medicines, but the carvedilol is the one for blood pressure. Any family history of heart problems?

Question
April 20, 2023, 5:57 PM EDT

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.

Question
April 20, 2023, 5:58 PM EDT

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.

Educate
April 20, 2023, 5:58 PM EDT

OK, thanks. Do you exercise?

Question
April 20, 2023, 5:59 PM EDT

Yeah, I exercise regularly. I do tai chi.

Educate
April 20, 2023, 5:59 PM EDT

Got it. Thanks. Any allergies?

Question
April 20, 2023, 5:59 PM EDT

No, I don’t have allergies.

Question
April 20, 2023, 6:00 PM EDT

I believe I’m up to date.

Question
April 20, 2023, 6:00 PM EDT

No. I’m good about taking my medicine.

Educate
April 20, 2023, 6:01 PM EDT

Great, it is good to take medications as prescribed. Have you ever had a heart attack?

Question
April 20, 2023, 6:01 PM EDT

Yes, I have had a heart attack.

Question
April 20, 2023, 6:02 PM EDT

My heart attack was five years ago. What are the symptoms of your heart attack?

Question
April 20, 2023, 6:03 PM EDT

The main thing I remember was really intense discomfort in my chest. Any history of hospitalizations?

Question
April 20, 2023, 6:03 PM EDT

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.

Question
April 20, 2023, 6:04 PM EDT

It doesn’t, really — it’s asymptomatic most of the time. Do you drink?

Question
April 20, 2023, 6:05 PM EDT

Yeah, I drink some.

Question
April 20, 2023, 6:05 PM EDT

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.

Educate
April 20, 2023, 6:08 PM EDT

Alright then. Thanks. Do you smoke?

Question
April 20, 2023, 6:08 PM EDT

I used to smoke.

Brian Foster Focused Exam: Chest Pain Shadow health

Question
April 20, 2023, 6:10 PM EDT

I quit smoking after my heart attack. I still get cravings though so I use the nicotine gum.

Educate
April 20, 2023, 6:10 PM EDT

Ah, I see. Have you ever had an EKG test?

Question
April 20, 2023, 6:11 PM EDT

Yeah, when I was hospitalized six months ago for heart failure stuff, they did an EKG and an echocardiogram.

Question
April 20, 2023, 6:12 PM EDT

Today it was 155 over 95. A little higher than normal. Any weight issues?

Question
April 20, 2023, 6:14 PM EDT

No, I’ve actually gained some.

Educate
April 20, 2023, 6:15 PM EDT

Gaining weight will only worsen your heart problems. Got it. Thanks. How much weight have you gained?

Question
April 20, 2023, 6:16 PM EDT

About four or five pounds. Any swelling?

Question
April 20, 2023, 6:16 PM EDT

Yeah, I have some swelling right now. Where is the swelling located?

Question
April 20, 2023, 6:17 PM EDT

In my feet and ankles. Any chest pain?

Question
April 20, 2023, 6:18 PM EDT

No, my chest hasn’t been hurting. Any palpitations?

Question
April 20, 2023, 6:19 PM EDT

I don’t have any palpitations at all. What caused our weight gain?

Question
April 20, 2023, 6:20 PM EDT

I don’t know, really. Have you been eating more?

Question
April 20, 2023, 6:20 PM EDT

My appetite’s been the same, pretty normal. [AUDIO COMING SOON] Do you monitor your heart problems?

Question
April 20, 2023, 6:21 PM EDT

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.

Question
April 20, 2023, 6:23 PM EDT

I drink decaf. How often do you exercise?

Question
April 20, 2023, 6:23 PM EDT

I do tai chi three times a week. Any skin problems?

Question
April 20, 2023, 6:24 PM EDT

No, my skin is normal, same as ever. Any fatigue?

Question
April 20, 2023, 6:24 PM EDT

I’m feeling OK — not tired. What is your occupation?

Question
April 20, 2023, 6:25 PM EDT

I’m retired now, but I worked as a truck driver for the postal service. What is your living situation?

Question
April 20, 2023, 6:25 PM EDT

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
April 20, 2023, 6:26 PM EDT

No issues with going to the bathroom, but I do wake up needing to pee at night. Any weakness?

Question
April 20, 2023, 6:26 PM EDT

I’m no Thor, but I can still open pickle jars when needed. Any breathing problems?

Question
April 20, 2023, 6:26 PM EDT

I haven’t had any issues with my breathing. Are you sexually active?

Question
April 20, 2023, 6:27 PM EDT

Yeah, things are just fine in the bedroom with my lady, Susan. Move the camera so your ankles are visible on the screen.

Question
April 20, 2023, 6:29 PM EDT

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
April 20, 2023, 6:29 PM EDT

Inspected right ankle: Edema is present on inspection of bilateral ankles without erythema or streaking. Move the camera so your ankles are visible on the screen, press your finger into the inner bony part of the ankle and hold for 1-2 seconds.

Question
April 20, 2023, 6:41 PM EDT

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
April 20, 2023, 6:41 PM EDT

Palpated left ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation. Hello. I am going to educate you about your medications.

Question
April 20, 2023, 7:33 PM EDT

Sounds good. Maintain a normal activity level, but discontinue exercise if you experience chest pain.

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 04/20/23 5:41 PM EDT
	Hi there.
	Can you hear me?	Question 04/20/23 5:41 PM EDT
	Yeah, I can hear you clearly.
	Are you in an appropriate environment for a telehealth visit?	Question 04/20/23 5:42 PM EDT
	This is a fine place for us to talk.
	Do you understand that this telehealth visit is confidential?	Question 04/20/23 5:43 PM EDT
	Yup, I understand that this visit is private and confidential. [AUDIO COMING SOON]
	What brings you here today? ORDER SHADOW HEALTH HELP HERE	Question 04/20/23 5:44 PM EDT
	I’m OK, just here for my regular telehealth follow-up.
	When was your last hospital visit?	Question 04/20/23 5:47 PM EDT
	Six months ago I was in the hospital for my heart failure symptoms.
	When were you diagnosed with heart failure?	Question 04/20/23 5:48 PM EDT
	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 04/20/23 5:48 PM EDT
	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 04/20/23 5:49 PM EDT
	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 04/20/23 5:50 PM EDT
	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 04/20/23 5:51 PM EDT
	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 04/20/23 5:53 PM EDT
	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 04/20/23 5:53 PM EDT
	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 04/20/23 5:55 PM EDT
	I was diagnosed with it five years ago, at the time of my heart attack.
	When were you diagnosed with high blood pressure?	Question 04/20/23 5:55 PM EDT
	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 04/20/23 5:56 PM EDT
	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 04/20/23 5:57 PM EDT
	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 04/20/23 5:58 PM EDT
	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 04/20/23 5:58 PM EDT
	OK, thanks.
	Do you exercise?	Question 04/20/23 5:59 PM EDT
	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 04/20/23 5:59 PM EDT
	Got it. Thanks.
	Any allergies?	Question 04/20/23 5:59 PM EDT
	No, I don’t have allergies.
	Are your immunizations current?	Question 04/20/23 6:00 PM EDT
	I believe I’m up to date.
	Have you missed any medications? (Clarified to Do you miss doses of your medication?.)	Question 04/20/23 6:00 PM EDT
	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 04/20/23 6:01 PM EDT
	Gotcha.
	have you ever had a heart attack?	Question 04/20/23 6:01 PM EDT
	Yes, I have had a heart attack.
	When did you last have a heart attack?	Question 04/20/23 6:02 PM EDT
	My heart attack was five years ago.
	What are the symptoms of your heart attack?	Question 04/20/23 6:03 PM EDT
	The main thing I remember was really intense discomfort in my chest.
	Any history of hospitalizations?	Question 04/20/23 6:03 PM EDT
	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 04/20/23 6:04 PM EDT
	It doesn’t, really — it’s asymptomatic most of the time. (Clarified to how my heart failure affects me.)
	Do you drink?	Question 04/20/23 6:05 PM EDT
	Yeah, I drink some.
	How often do you drink?	Question 04/20/23 6:05 PM EDT
	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 04/20/23 6:08 PM EDT
	Alright then. Thanks.
	Do you smoke	Question 04/20/23 6:08 PM EDT
	I used to smoke.
	When did you last smoke?	Question 04/20/23 6:10 PM EDT
	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 04/20/23 6:10 PM EDT
	Ah, I see.
	Have you ever had an EKG test?	Question 04/20/23 6:11 PM EDT
	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 04/20/23 6:12 PM EDT
	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 04/20/23 6:14 PM EDT
	No, I’ve actually gained some. (Clarified to if I have lost weight.)
	Gaining weight will only worsen your heart problems	Educate 04/20/23 6:15 PM EDT
	Got it. Thanks.
	How much weight have you gained?	Question 04/20/23 6:16 PM EDT
	About four or five pounds.
	Any swelling?	Question 04/20/23 6:16 PM EDT
	Yeah, I have some swelling right now.
	Where is the swelling located?	Question 04/20/23 6:17 PM EDT
	In my feet and ankles.
	Any chest pain?	Question 04/20/23 6:18 PM EDT
	No, my chest hasn’t been hurting.
	Any palpitations?	Question 04/20/23 6:19 PM EDT
	I don’t have any palpitations at all.
	What caused our weight gain?	Question 04/20/23 6:20 PM EDT
	I don’t know, really.
	Have you been eating more? (Clarified to Is your appetite fine?.)	Question 04/20/23 6:20 PM EDT
	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 04/20/23 6:21 PM EDT
	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 04/20/23 6:23 PM EDT
	I drink decaf.
	How often do you exercise?	Question 04/20/23 6:23 PM EDT
	I do tai chi three times a week.
	Any skin problems?	Question 04/20/23 6:24 PM EDT
	No, my skin is normal, same as ever.
	Any fatigue?	Question 04/20/23 6:24 PM EDT
	I’m feeling OK — not tired.
	What is your occupation?	Question 04/20/23 6:25 PM EDT
	I’m retired now, but I worked as a truck driver for the postal service.
	What is your living situation?	Question 04/20/23 6:25 PM EDT
	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 04/20/23 6:26 PM EDT
	No issues with going to the bathroom, but I do wake up needing to pee at night.
	Any weakness?	Question 04/20/23 6:26 PM EDT
	I’m no Thor, but I can still open pickle jars when needed.
	Any breathing problems?	Question 04/20/23 6:26 PM EDT
	I haven’t had any issues with my breathing.
	Are you sexually active?	Question 04/20/23 6:27 PM EDT
	Yeah, things are just fine in the bedroom with my lady, Susan.
	move the camera so your ankles are visible on the screen	Question 04/20/23 6:29 PM EDT
	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 04/20/23 6:29 PM EDT
	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 04/20/23 6:29 PM EDT
	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 04/20/23 6:41 PM EDT
	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 04/20/23 6:41 PM EDT
	Palpated left ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation	Exam Action 04/20/23 6:41 PM EDT
	Hello. I am going to educate you about your medications	Question 04/20/23 7:33 PM EDT
	Sounds good.
	maintain normal activity level, bur discontinue exercise if you experience chest pain	Question 04/20/23 7:34 PM EDT
	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 04/20/23 7:35 PM EDT
	Will do. I am very good about my fluid restrictions.
	Avoid drinking alcohol	Question 04/20/23 7:35 PM EDT
	Alright, I’ll lay off the alcohol.
	Avoid drinking caffeinated beverages	Question 04/20/23 7:36 PM EDT
	OK, no caffeine, but is decaf fine?
	No	Question 04/20/23 7:36 PM EDT
	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 04/20/23 7:37 PM EDT
	That’s a smart trick. OK, I’ll do that.
	Ask your provider for a referral to a clinical dietitian ORDER SHADOW HEALTH HELP HERE	Question 04/20/23 7:38 PM EDT
	OK, that’s a good tip.
	Adhere to your low-sodium diet, and pay attention to labels to avoid foods high in sodium	Question 04/20/23 7:40 PM EDT
	Sounds good. I’ll avoid those high-sodium foods, but what foods should I look at the labels for again?
	All foods	Question 04/20/23 7:41 PM EDT
	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 04/20/23 7:43 PM EDT
	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 04/20/23 7:43 PM EDT
	OK, I’ll watch out for those signs and symptoms carefully.
	Test for swelling by performing a pitting edema test	Question 04/20/23 7:44 PM EDT
	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 04/20/23 7:46 PM EDT
	OK, that’s good to know.
	Look out for signs of fluid overload, like weight gain, fatigue during activity	Question 04/20/23 7:47 PM EDT
	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 04/20/23 7:48 PM EDT
	I definitely will.
	Follow up with your cardiologist	Question 04/20/23 7:49 PM EDT
	I’ll call my cardiologist if that happens.
	Set a reminder for your medications	Question 04/20/23 7:49 PM EDT
	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 04/20/23 7:51 PM EDT
	Thanks, those are good suggestions.
	Take furosemide with the potassium chloride to maintain adequate potassium	Question 04/20/23 7:52 PM EDT
	I’ll do that, then.
	Take the furosemide with potassium chloride tablet for edema even if you have minor swelling	Question 04/20/23 7:53 PM EDT
	I will!
	Beware of symptoms that indicate worsening condition	Question 04/20/23 7:54 PM EDT
	Sounds good. I’ll keep an eye out for when to take those meds.
	Thanks for listening, Goodbye	Question 04/20/23 7:55 PM EDT Dont wait until the last minute. Provide your requirements and let our native nursing writers deliver your assignments ASAP. Start My Order
	Alright. Thank you for your help. Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient