Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient

Liam Fitzgerald. Host: Hi, I’m here to talk to you and check on your health.
Liam Fitzgerald: Hello.
Host: Can you hear me?
Liam Fitzgerald: Yes, I can hear you clearly.
Host: Are you in a good place for our telehealth visit?
Liam Fitzgerald: Yes, this is a suitable spot for our conversation.
Host: Do you understand that our conversation is private and confidential?
Liam Fitzgerald: Yes, I understand that this visit is confidential.
Host: What’s the reason for today’s visit?
Liam Fitzgerald: I’m here for my regular telehealth check-up. I’m feeling fine.
Host: When was your last hospital visit?

Liam Fitzgerald: I was last in the hospital six months ago due to my heart issues.
Host: When were you diagnosed with heart failure?
Liam Fitzgerald: I was diagnosed with heart failure about two years ago.
Host: Do you know what symptoms you’re currently experiencing?
Liam Fitzgerald: I don’t have any symptoms at the moment. I’m just here for a follow-up.
Host: Are you taking any medications?
Liam Fitzgerald: Yes, I’m on several medications for my heart, including carvedilol, candesartan, spironolactone, and aspirin. I also have some as-needed medications like furosemide, potassium chloride, and nitroglycerin. For cholesterol, I take atorvastatin and fish oil.

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Host: What are the dosages of your medications?

Liam Fitzgerald: I have different dosages for my regular heart medications, so we can go through that list. Carvedilol is 12.5 milligrams, candesartan is 32 milligrams, spironolactone is 12.5 milligrams, and aspirin is an 81 mg EC tablet. As for cholesterol, atorvastatin is 40 mg, and fish oil is 1000 mg, and I take both daily.

Host: Can you tell me about your medical history?

Liam Fitzgerald: I’ve had heart failure for a while. I also have coronary artery disease, high blood pressure, high cholesterol, and I had a heart attack some time ago.

Host: When were you diagnosed with coronary artery disease?

Liam Fitzgerald: I found out about my coronary artery disease when I had my heart attack five years ago.

Host: When were you diagnosed with high blood pressure?

Liam Fitzgerald: I’ve had high blood pressure for a while. I was diagnosed at 38 but didn’t manage it well back then. It’s under control now.

Host: How do you manage your blood pressure?

Liam Fitzgerald: I’m on a few heart medicines, but carvedilol is the one I take for my blood pressure.

Host: Do you have a family history of heart problems?

Liam Fitzgerald: Yes, heart issues run in my family. My mom has high blood pressure and high cholesterol, and my dad passed away at 75 from a heart condition. He also had high blood pressure and had open-heart surgery.

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Host: What’s your typical diet like?

Liam Fitzgerald: I follow a low-sodium diet as best as I can. For breakfast, I have oatmeal with berries. Lunch is often homemade soup or pasta with grilled chicken and veggies. Sometimes I have a salad. Dinner consists of fish or grilled chicken, more veggies, and brown rice. If I snack, it’s usually air-popped, no-salt popcorn or an apple with no-salt almond butter.

Host: That’s a healthy diet.

Liam Fitzgerald: Yes, it’s what I need to do.

Host: Do you engage in any physical activity?

Liam Fitzgerald: I practice tai chi regularly.

Host: That’s great. Physical activity is good for your health.

Liam Fitzgerald: I’ll keep it up.

Host: Do you have any allergies?

Liam Fitzgerald: No, I don’t have any allergies.

Host: Are your immunizations up to date?

Liam Fitzgerald: I believe they are.

Host: Do you ever miss taking your medications?

Liam Fitzgerald: No, I’m pretty good at taking my medicines.

Host: That’s important for managing your health.

Liam Fitzgerald: I understand.

Host: Have you ever had a heart attack?

Liam Fitzgerald: Yes, I had a heart attack five years ago.

Host: Can you tell me more about the symptoms you experienced during your heart attack?

Liam Fitzgerald: The main thing I remember is intense discomfort in my chest.

Host: Have you had any recent hospitalizations?

Liam Fitzgerald: I’ve been to the hospital a few times. Besides the heart attack five years ago, I had issues with my heart two years ago, which led to a diagnosis of heart failure. And six months ago, I was back in the hospital due to my heart.

Host: How does your heart condition affect you?

Liam Fitzgerald: Most of the time, it doesn’t affect me. I’m usually asymptomatic.

Host: Do you drink alcohol?

Liam Fitzgerald: Yes, I do, but not very often these days, mostly on special occasions. I used to have one or two beers nightly, but I cut down after my heart attack. Sometimes, I have non-alcoholic drinks, but I prefer the real thing if I’m going to drink.

Host: Drinking too much alcohol is not good for your health.

Liam Fitzgerald: I understand.

Host: Do you smoke?

Liam Fitzgerald: I used to smoke.

Host: When did you quit smoking?

Liam Fitzgerald: I quit after my heart attack. I still get cravings, so I use nicotine gum.

Host: Smoking is not good for your health.

Liam Fitzgerald: I get it.

Host: Have you ever had an EKG test?

Liam Fitzgerald: Yes, they did an EKG and an echocardiogram when I was hospitalized six months ago for heart failure.

Host: Do you know your blood pressure number?

Liam Fitzgerald: Today, it was 155 over 95. A bit higher than usual.

Host: Have you lost weight recently?

Liam Fitzgerald: No, I’ve actually gained some.

Host: Gaining weight can worsen your heart problems.

Liam Fitzgerald: I understand.

Host: How much weight have you gained?

Liam Fitzgerald: About four or five pounds.

Host: Have you experienced any swelling?

Liam Fitzgerald: Yes, I have some swelling, mainly in my feet and ankles.

Host: Do you have chest pain?

Liam Fitzgerald: No, my chest hasn’t been hurting.

Host: Any palpitations?

Liam Fitzgerald: I haven’t had any palpitations.

Host: What do you think caused your recent weight gain?

Liam Fitzgerald: I’m not sure, really.

Host: Have you been eating more?

Liam Fitzgerald: My appetite is about the same as usual.

Host: Are you monitoring your heart condition?

Liam Fitzgerald: I do have some swelling right now, and I have several heart conditions, including coronary artery disease, heart failure, high cholesterol, high blood pressure, and a past heart attack.

Host: Do you consume caffeine?

Liam Fitzgerald: I drink decaf.

Host: How often do you exercise?

Liam Fitzgerald: I practice tai chi three times a week.

Host: Any skin problems?

Liam Fitzgerald: My skin is normal, no issues.

Host:

Are you experiencing fatigue?

Liam Fitzgerald: I’m feeling fine and not tired.

Host: What was your occupation?

Liam Fitzgerald: I’m retired now, but I used to work as a truck driver for the postal service.

Host: What’s your living situation?

Liam Fitzgerald: I live in a one-story house with my daughter Claire, her husband Mark, and my grandson, Callum.

Host: Any urination issues?

Liam Fitzgerald: No issues, but I do wake up at night to urinate.

Host: Any weakness?

Liam Fitzgerald: I’m not super strong, but I’m not experiencing any significant weakness.

Host: Any breathing problems?

Liam Fitzgerald: I haven’t had any breathing issues.

Host: Are you sexually active?

Liam Fitzgerald: Yes, everything is okay in that department with my partner, Susan.

Host: Can you adjust your camera to show your ankles?

Liam Fitzgerald: Sure, let me do that.

Host: Inspected left ankle: There’s edema present in both ankles without redness or streaking.

Host: Inspected right ankle: Edema is present in both ankles without redness or streaking.

Host: Can you press your finger into the inner bony part of your ankle and hold for 1-2 seconds?

Liam Fitzgerald: Alright, let me move the camera again.

Host: Palpated right ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth.

Host: Palpated left ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth.

Host: I’d like to educate you about your medications.

Liam Fitzgerald: That sounds good.

Host: Maintain normal activity levels, but stop exercising if you experience chest pain.

Liam Fitzgerald: I’ll stop exercising and contact my cardiologist if I get chest pain.

Host: Stick to a fluid volume restriction of 1.5 liters per day.

Liam Fitzgerald: I’m good at following my fluid restrictions.

Host: Avoid drinking alcohol.

Liam Fitzgerald: I’ll lay off the alcohol.

Host: Avoid drinking caffeinated beverages.

Liam Fitzgerald: Alright, I’ll be cautious even with decaf.

Host: Maintain a diet with lean meat, whole grains, fresh fruits, and vegetables, and use spices instead of salt for seasoning.

Liam Fitzgerald: That’s a smart choice. I’ll do that.

Host: Ask your provider for a referral to a clinical dietitian.

Liam Fitzgerald: That’s a good tip.

Host: Adhere to your low-sodium diet and pay attention to labels to avoid high-sodium foods.

Liam Fitzgerald: I’ll check food labels carefully for sodium content.

Host: Be mindful of symptoms that indicate a worsening condition and take your diuretic as directed.

Liam Fitzgerald: I’ll watch for symptoms and take the medication as needed.

Host: Set a timer for 30 minutes after experiencing symptoms before taking furosemide and potassium chloride.

Liam Fitzgerald: I’ll make sure to wait for 30 minutes.

Host: Test for swelling by performing a pitting edema test.

Liam Fitzgerald: I’ll watch for swelling and be cautious.

Host: Be alert for fatigue.

Liam Fitzgerald: I’ll be aware of any fatigue.

Host: Look out for signs of fluid overload, such as weight gain and fatigue during activity.

Liam Fitzgerald: I’ll be vigilant and monitor for these symptoms.

Host: If your condition worsens, go to the hospital.

Liam Fitzgerald: I’ll definitely go if my condition gets worse.

Host: Follow up with your cardiologist.

Liam Fitzgerald: I’ll call my cardiologist if needed.

Host: Set reminders for taking your medications.

Liam Fitzgerald: I’ll let my girlfriend and daughter know about the reminders.

Host: If you take medications as needed, your girlfriend and daughter can remind you.

Liam Fitzgerald: Those are good suggestions. Thank you.

Host: Take furosemide with potassium chloride to maintain adequate potassium.

Liam Fitzgerald: I’ll make sure to do that.

Host: Take the furosemide with potassium chloride tablet for edema, even if the swelling is minor.

Liam Fitzgerald: I will follow that advice.

Host: Be watchful for symptoms indicating a worsening condition.

Liam Fitzgerald: I’ll keep an eye out for when to take those medications.

Host: Thanks for listening, and take care.

Liam Fitzgerald: Thank you for your help.