C09998554 / invoice 10000

Reason: Appt: CoughingAppointment Notes: Overdue remindersHistory: Cough has increased in frequency. Has always had a honking cough. Over the last month has even getting deeper, and more frequent EDUF normal, no V+/D+Cardisure, seems to be working well. MMVD / tricuspid insufficiencyHas not been measuring SRRExamination: BARBSC 7/9EENO normalMM PM, CRT<2sLNs WNLHR 100, grade 4-5/6 murmur left systolic. Normal rhythm. RR 24, normal lung sounds bilaterallyAbdo comfortable, no organomegalyCoat WNLAssessment: 1. MMVD Stage B22. Chronic cough Ddx: Left atrial enlargement causing tracheal narrowing, tracheal collapse, pulmonary hypertension, CHF Client communications: Discussed PE and history with O. Discussed differentials for cough. Suspect tracheal in origin based on characteristics of cough, however strongly recommended measuring SRR and if >30 present to ECC. Showed Heart2Heart app. Plan: - Restart measuring SRR - if SRR stable can consider antitussive  - Weightloss (ideal weight 10kg)- Continue pimobendan    Vital Signs    Weight: 12;