Todd Babel | MyRecord

September 10, 2004

ECHOCARDIOGRAM

RE: Todd Babel
DOB:10/28/1956

ORDERING PHYSICIAN: Larry Grider, M.D., FACC
SONOGRAPHER: R. B. Waddsworth

INDICATIONS: Followup of aortic valve stenosis, mitral regurgitation, and tricuspid regurgitation.

CARDIAC MEASUREMENTS:
RVDd 2.6 0.9-2.6 (cms) 1.5 (mean)
IVSd 1.3 0.6-1.1 (cms) 0.9 (mean)
LVIDd 3.6 3.5-5.7 (cms) 4.7 (mean)
LVIDs 2.3-3.9 (cms) 3.1 (mean)
LVPWd 1.2 0.6-1.1 (cms) 0.9 (mean)
Aortic root 3.6 2.0-3.7 (cms) 2.7 (mean)
Aortic cusp separation 1.3 1.5-2.6 (cms) 1.9 (mean)
LAD 4.0 1.9-4.0 (cms) 2.9 (mean)

FINDINGS: Technical quality of the study is good. The left ventricle is normal in size. There is mild, concentric left ventricular hypertrophy with uniform systolic contractility and the ejection fraction is 61% by Teichholz determination. The left atrium measured at the upper limits of normal. The right atrium, right ventricle, and aortic root are normal in size. The mitral leaflets are moderately thickened, but open normally. There is posterior mitral annular calcification present. The aortic valve is heavily thickened and calcified and likely is trileaflet in nature. There is excursion of the valve leaflets. The pulmonic valve is not seen. The tricuspid valve appeared to be normal.

Doppler examination demonstrates mild mitral insufficiency. Transmitral filling is abnormal as is tissue Doppler suggestive of diastolic dysfunction. The maximum velocity across the aortic valve is 2.0 cm/sec giving a peak gradient of 28 and a mean gradient of 15 with valve orifice area at 1.2 cm2. There is mild-to-moderate aortic insufficiency as well with a pressure half time of 424 msec. There is no pulmonic insufficiency. There is trivial tricuspid insufficiency with RV systolic pressure of 45 mmHg.
Re: Joseph Ferraro
September 10, 2004
Page 2

IMPRESSION:
1.Intact left ventricular systolic function with mild, concentric left ventricle hypertrophy.
2.Moderate aortic valve stenosis with valve orifice area of 1.2 cm2.
3.Mild-to-moderate aortic insufficiency.
4.Mild mitral insufficiency with mitral valve sclerosis and mitral annular calcification.
5.Trivial tricuspid insufficiency with mild-to-moderate pulmonary hypertension.

Rodger Pinto, M.D.., FACC
RP/vet #77080434
DD: 09/10/2004
DT: 09/11/2004
Dictated but not read to expedite transmission

Document electronically signed by : Dr. Rodger Pinto, M.D. Date : 10/13/2004 Time : 8:48:50 AM

Exercise Dual Isotope Myocardial Perfusion Study

Study Date: April 21, 2004

Patient Name: Todd Babel
Date of Birth: 10-28-56

Ordering Physician: Larry Grider, M.D.
Cc: Rodger Pinto,M.D.

Indication: The patient is a 48 year old man with known coronary artery disease. The study is done to look for further progression of his disease.

Patient was informed of risks and benefits of the test, and a written consent was obtained. The resting SPECT images were acquired after the patient was injected with 3.04 mCi of thallous chloride. Following completion of the resting scan, patient underwent an exercise test according to the exercise protocol.

The patient underwent a stress test during which he exercised for 7 minutes on Bruce protocol reaching a maximal heart rate of 140. This corresponded to 93% of his maximal predicted heart rate and 10.1 METS. He did not have any chest pain and there were no ischemic EKG changes.

At peak exercise patient was injected with 37.7 mCi of technetium sestamibi. Patient then underwent a repeat nuclear scan to obtain post-exercise images. The post-exercise images were gated. The results were as follows.

Technical quality of the study was good.

The perfusion images showed a small mild reversible defect of the inferior wall equivocal for ischemia.

Exercise induced transient left ventricular cavity dilatation was not seen.

There are no previous studies for comparison.

CONCLUSIONS:
1.The study was equivocal.
2.Small area of equivocal inferior wall ischemia.
3.Normal left ventricular cavity size.
4.Normal wall motion.
5.Ejection fraction is estimated at 58%.

Connie C. Chong, M.D.
Interpreting Physician

Document electronically signed by : Connie C. Chong, MD Date : 05/12/2004 Time : 11:02:24 AM

DATE: 12/16/2004

BABEL, TODD

DATE OF BIRTH: 10/29/1956
AGE: 48 years old
MRNO: 999999

CURRENT DIAGNOSES

1. Hypertension (Benign), 401.1
2. Left Ventricular Hypertrophy, 429.3
3. Aortic Valve-Stenosis, 424.1
4. Mitral Valve-Regurgitation, 424.0
5. Tricuspid Valve-Regurgitation, 424.2
6. CAD, 414.01
7. Pleural Effusion, 511.9
8. S/P AVR (Homograft), V42.2
9. Chest Pain, unspecified, 786.50
__
ALLERGIES

NKA
__
MEDICATIONS

1. Aspirin Enteric Coated 81 mg, 1 p.o. q.d.
2. Lasix 20 mg, 1 p.o. daily
3. Lipitor 40mg, 1 by mouth daily
4. Lopressor 100 mg, 1 p.o. b.i.d.
4. MVI with iron, 1 p.o. b.i.d.
5. Niacin TR 1500mg, 1 p.o. daily
6. Nitrolingual 0.4 mg, PRN
7. Norvasc 10mg, 1 by mouth daily
8. Xanax 0.25 mg, Q8H PRN
__
CHIEF COMPLAINTS
Followup of - CAD, Followup of - Chest Pain, unspecified and Followup of Aortic Valve-Stenosis
__
HISTORY OF PRESENT ILLNESS
Mr. Babel was seen in the office today in followup of his cardiovascular problems. Since his last visit here, he states that he has been doing well. He denies any significant chest discomfort, shortness of breath, palpitations, or dizziness. He has had some left pleural effusion on chest x-rays. He has been somewhat reluctant to have a thoracentesis; therefore, he was placed on low doses of Lasix, and we will repeat the chest x-ray in early January to see if the effusion is resolving.

__
PAST HISTORY

CARDIAC/VASCULAR ILLNESSES : aortic stenosis, LVH, mild tricuspid regurgitation, mild mitral regurgitation

CARDIAC/VASCULAR SURGERIES : CABG September 2004, AVR September 2004

CARDIAC INVASIVE PROCEDURES : cardiac cath (left) Sept 2004

CARDIAC NON-INVASIVE PROCEDURES : echocardiogram Sept 2003, fast CT Aug 2003, dual isotope stress April 2004, echocardiogram Sept 2004, treadmill Nov 2004

PERIPHERAL VASCULAR PROCEDURES : no previous peripheral vascular procedures

LEFT VENTRICULAR EF : EF 58% by nuclear study

PAST MEDICAL ILLNESSES : hypertension; Surgeries/Procedures: knee surgery, left; Infectious History: childhood illnesses of mumps, measles and chickenpox; Trauma History: no history of trauma
__
FAMILY HISTORY:

Father - Age 65, cirrhosis (ETOH abuse); Mother - Age 73, cancer-unknown type and diabetes-Type I (IDDM); Brother 1 - alive and well; Sister 1 - alive and well;
__
SOCIAL HISTORY

Alcohol Use - does not use alcohol; Smoking - does not smoke; Diet - regular diet and tries to eat low fat foods; Lifestyle - married; Education - high school diploma; Exercise - exercise is limited due to physical disability; Seat Belt Use - never; Occupation - retired; Illicit Drug Use - denies substance abuse; Sexual Activity - did not discuss sexual history; Residence - lives with wife; Place of Birth - Pennsylvania; Spouse's Occupation - retired;
__
REVIEW OF SYSTEMS

General: denies recent weight loss, weight gain, fever or chills or change in exercise tolerance.; Integumentary: denies any change in hair or nails, rashes, or skin lesions.; Eyes: wears eye glasses/contact lenses; Ears, Nose, Throat, Mouth: denies any hearing loss, epistaxis, hoarseness or difficulty speaking.; Respiratory: denies dyspnea, cough, wheezing or hemoptysis.; Cardiovascular: negative for palpitations, chest pain, orthopnea, PND, peripheral edema, syncope or claudication.; Abdominal: denies ulcer disease, hematochezia or melena.; Musculoskeletal: denies any history of venous insufficiency, arthritic symptoms or back problems.; Neurological: denies any history of recurrent strokes, TIA, or seizure disorder.; Psychiatric: sleep disturbance; Endocrine: denies any history of weight change, heat/cold intolerance, polydipsia, or polyuria; Hematologic/Immunologic: denies any food allergies, seasonal allergies, bleeding disorders.

__
PHYSICAL EXAMINATION

VITAL SIGNS :

Blood Pressure :
132/82 Sitting, Left arm, regular cuff
128/80 Sitting, Right arm, regular cuff

Pulse 76/min.

Weight - 175.00 lbs.
Height - 68.5"

CONSTITUTIONAL
well developed, well nourished, in no acute distress

SKIN
warm and dry to touch, surgical scars well-healed

HEAD
normocephalic

NECK
no JVD, no bruits, no masses, non-tender

CHEST
clear to auscultation

CARDIAC
regular rhythm, S1 normal, S2 normal, no murmurs, gallops or rubs detected

ABDOMEN
non-tender, no masses, no bruits, aorta, liver and spleen not palpated, bowel sounds normal

PERIPHERAL PULSES
pulses full and equal in all extremities

EXTREMITIES & BACK
no cyanosis present, no clubbing present, no edema present

PSYCHIATRIC
no difficulties with speech or language

NEUROLOGICAL
no gross motor or sensory deficits noted

MEDICATIONS UPDATED TODAY

MEDICATION STOPPED TODAY
Ambien 10 mg, Amiodarone Hydrochloride 200 Mg and Coumadin 2.5 mg

IMPRESSIONS/PLAN

Since he is doing well, I have gone ahead and discontinued his Coumadin and amiodarone. He will remain on his other medications as before. He will continue with his exercise regimen and risk factor modification.

Chest x-ray will be checked in three weeks. If that looks good, I will see him back in the office in three months. I am certainly available sooner if needed.

__

TODAYS ORDERS

1. Return Visit 3 months
2. Chest X-ray PA/Lat 3 weeks

Referring Physician: SCOTTL M.D., JASON

lgrider

Document electronically signed by : Dr. Larry Grider Date : 1/13/2005 Time : 6:38:21 PM

December 16, 2004

Jason Scott, M.D.
9000 North Main Street, Suite 305
Chatswort, CA 91311

Re: Todd Babel
DOB: 10/28/1956

Dear Dr. Scott:

Mr. Babel was seen in the office today in followup of his cardiovascular problems. Since his last visit here, he states that he has been doing well. He denies any significant chest discomfort, shortness of breath, palpitations, or dizziness. He has had some left pleural effusion on chest x-rays. He has been somewhat reluctant to have a thoracentesis; therefore, he was placed on low doses of Lasix, and we will repeat the chest x-ray in early January to see if the effusion is resolving.

Since he is doing well, I have gone ahead and discontinued his Coumadin and amiodarone. He will remain on his other medications as before. He will continue with his exercise regimen and risk factor modification.

Chest x-ray will be checked in three weeks. If that looks good, I will see him back in the office in three months. I am certainly available sooner if needed.

Sincerely,

Larry Grider, M.D., FACC
LG/sol # 999999999
DD: 12/16/2004
DT: 12/17/2004
Dictated but not read to expedite transmission

Document electronically signed by : Dr. Larry Grider Date : 1/13/2005 Time : 6:38:21 PM