C10004244 / invoice 10000

Reason: Echocardiography ExamHistory:Cardiovascular Physical exam:Thoracic auscultation revealed a 2/6 left apical systolic heart murmur with regular rhythm.  The lung sounds were within normal limits. The mucous membranes were pink and the CRT was normal. Pulses were strong, synchronous and symmetrical. Echocardiographic findings:The mitral valve is thickened and prolapses into the left atrium during systole. There is a small volume mitral regurgitant jet occupying approximately 5% of the left atrium. There is no evidence of left atrial enlargement or  left ventricular volume overload.  The left ventricular systolic function is normal. The tricuspid valve is mildly irregular. There is a small volume tricuspid regurgitant jet measuring m/s. There is no evidence of right  atrial enlargement or pulmonary hypertension. The ventricular inflow is within normal limits, Mitral E 1.05, Mitral A0.63, E/A ratio 1.65.There is a small volume pulmonic regurgitant jet measuring 0.84m/s. The aortic valve is within normal limits with no insufficiency.  There is no evidence of arrhythmias, mass lesions or effusions.Ao1.04 [1.2-1.8] LA1.47 [1.1-1.8] LA/Ao 1.41IVSd 0.77 [0.4-0.9] LVIDd 2.47 [2.2-3.1] LVWd 0.59 [0.4-0.9] IVSs 1.03 [0.7-1.2] LVIDs 1.50 [1.2-2.2] LVWs 0.97  [0.7-1.3]LVIDDn 1.5EF  72 %FS   39 %IVS  34 %PW   66%LVmass 105MRVp   2.16m/s,     MRGp 18.7  mmHgTRVp  1.06  m/s,    TRGp  4.5   mmHGRVOT   0.99m/s,   3.9 mmHGPAVp   1.39  m/s,    PAGp 7.7  mmHGLVOT    1.28 m/s          6.5     mmHGAOVp 1.78   m/s,    AOGp: 12.7 mmHGLA long axis 18.3   mmRA long axis  16.5  mmLong axis LVIDd   25.7 mmEPSS  0.88 mm Assessment: The findings are consistent with stage B1 myxomatous mitral and tricusoid valve disease. Treatment: No medications are required at this stage. Recommend repeat echo in 12 monthsReason: Echocardiography ExamHistory:Cardiovascular Physical exam:Thoracic auscultation revealed a #/6 left apical systolic heart murmur with regular rhythm.  The lung sounds were within normal limits. The mucous membranes were pink and the CRT was normal. Pulses were strong, synchronous and symmetrical. Echocardiographic findings:@The mitral valve is thickened and prolapses into the left atrium during systole. There is a @volume mitral regurgitant jet occupying approximately @ of the left atrium. There is  # evidence of left atrial enlargement and # left ventricular volume overload. # The left ventricular systolic function is normal. @The tricuspid valve appears mildly irregular. @There is a small volume tricuspid regurgitant jet with no evidence of right atriomegaly or venous congestion. #The tricuspid regurgitant jet velocity is normal, with no evidence of pulmonary hypertension.#The ventricular inflow is within normal limits, Mitral E @, Mitral A @, E/A ratio @.@The aortic and pulmonary valves are within normal limits with no insufficiency.  There is no evidence of arrhythmias, mass lesions or effusions.IVSd LVIDdLVPWdIVSsLVIDsLVPWsEF   %FS    %IVS    %PW   %LVmassAo: LA: LA/AoMRVp   m/s,     MRGp    mmHgTRVp    m/s,    TRGp     mmHGRVOT   m/s,    mmHGPAVp     m/s,    PAGp   mmHGLVOT     m/s                 mmHGAOVp    m/s,    AOGp:  mmHGLA long axis     mmRA long axis    mmLong axis LVIDd    mmEPSS   mm Mitral E waveMitral A waveMitral E/A wave.    Vital Signs    Weight: 5.9;       

Reason: Annual Health Check, Nail ClipAppointment Notes: jmSubjective and history: On lykaHas a day where gets 'the gurgles' noisy tummy and off food.1 day later is fine again.Stool can be a little soft, then fine again.Not really scavenging.Objective:LHL MPL grade 3 - grindingRHL grade 2 MPLGrade 2/6 systolic murmur - new murmurOtherwise okTreatment: ProheartLepto 2PibbPlan: Echo next week with JVEither TPS appointment or book in for EB to check I have advised Millie likely to benefit from surgery on LHL - O keen to get specialist opinion    Vital Signs    Weight: 5.9;       

Reason: Bravecto Quantum InjectionAppointment Notes: khHistory: Wants quantumNo rxn to PO bravectoEDDU normalOnly concern is destructive when o away from homePhysical Exam: BARVitals WNLsNAD cardiopulmonary auscNAD abdo palpLNs normalTreatment: Bravecto quantum 0.56ml SCNails clipped    Vital Signs    Weight: 5.6;