Document JJe6Q6qXmew6aEBMqkMyj4mer

SMC 000194 o4/25/2006 12157 JH fBOHl Bllvua Cardiology clinic toi 1-425-465-007 Bellevue Cardiology A Member {fCnflmeotn CttaMtavof Wnfttam Bhllevue Cardiology Clinic M8^!! 1414 UfthNiL, Stole E BeBevue, WA 98004 (425) 455-9555 SMITH, DEANE R. DOB: 10/18/1927 April 20,2006 DEVICE CHECK Referring physician: Peter Kures, MD Primary care physician: Barry L. Marmoretaln, MD . IDENTIFICATION: Deane Smith Is a pleasant 78-year-old gentleman seen for follow-up of his pacemaker. CARDIOVASULAR PROBLEM LIST: 1. Coronary artery disease with nonobstructive lesions including a 50% LAD, 40% circumflex, and 25% right coronary stenosis bn cardiac oath 2002. 2. Chronic atrial fibrHation. 3. Status post-single chamber pacemaker for bradycardia. 4. Preserved left ventricular function with estimated ejection fraction 52% by exercise nuclear scan May 2005. HISTORY OF PRESENT ILLNESS: Mr. Smith is a pleasant 7B-year-old gentleman seen for follow up of Ns pacemaker. Overall, he has done quite well denying palpitations, syncope, near syncope, lightheadedness, shortness of breath, or chest pain. He continues on Coumadin therapy without difficulty. CURRENT MEDICATIONS: Coumadin. Metoprolol 50 mg q,d. PHYSICAL EXAMINATION: Pleasant elderly male In no acute distress. VITAL SIGNS: Weight 196 pounds. BP 136/64. Pulse 60 regular. Respirations 14 non labored. DEVICE INTERROGATION: Demonstrates a Guidant Insignia 1 Plus single chamber pacemaker set SSIR 66-130. Capture threshold is .6 volts at .3 miiHseconds and lead impedance is 440 ohms. Sensing amplitude is 6.8 mfiBvotts, and he is pacing In the ventricle 60% of the tune. He has episodes of high ventricular rates, which appear to be consistent with atrial fibrillation. He Is asymptomatic in this regard. IMPRESSION/PLAN: 1. Pacemaker. The device Is functioning appropriately with stable lead parameters. He is pacing In the ventricle 60% of the time and still has evidence for rapid ventricular responses intermittently. We have extended the ventricular refractory period from .250 to 260 mWseconds to confirm no over-sensing. No other programming changes are made at this time. DISPOSITION: Mr. Smith will return in three months tor routine device check. We will consider increasing his Toprol should he have continued high rate episodes. JVF/fb Cc: Peter Kures, M.D. Barry L. Marmorsteln, M.D. vm fax (425) 4354)070 Jeffrey V. Fowler, M.D. SMC 000194 D-1069