HISTORY OF PRESENT ILLNESS
Mr. Varner is a gentleman with a history of aortic valve disease, status post aortic valve replacement with a St. Jude mechanical prosthesis in 2007. He also has a history of paroxysmal atrial fibrillation and nonobstructive coronary artery disease. He reports that he remains active, exercises regularly, lifting weights and walks up to several miles a day without any chest pain or shortness of breath. He denies any syncope or near syncope. No edema, orthopnea, or PND. He has rare fleeting palpitations which last only a few seconds, and are stable. He does have a history of paroxysmal atrial fib. He has been anticoagulated with warfarin chronically. Reports occasional blood tinge when he blows his nose hard, particularly when the air is dry. No hemoptysis, melena, hematochezia, or hematuria. Denies any symptoms of stroke or TIA. Last echocardiogram in 07/2016 demonstrated normal LV systolic function with hemodynamics consistent with mild-to-moderate stenosis of the aortic prosthesis. There was no AI. Last lipid panel shows an LDL of 112, HDL 48, triglycerides of 85 on atorvastatin 40 mg p.o. daily.…show more content… Weight 162.8, blood pressure 136/68, pulse 64 and regular, temperature 97.7, O2 sats 96% on room air. Neck is without JVD. The cardiac rhythm is regular with a crisp mechanical second heart sound with a grade 2-3/6 systolic murmur peaking in mid systole. No diastolic murmurs or gallops are appreciated. The lungs are clear. Abdomen is soft. Extremities have no
