Shadow Health Assignments
Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
Greet
04/20/23 5:41 PM EDT
Liam Fitzgerald: Hi there.
Your Avatar: Can you hear me?
Question
04/20/23 5:41 PM EDT
Liam Fitzgerald: Yeah, I can hear you clearly.
Your Avatar: Are you in an appropriate environment for a telehealth visit?
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Question
04/20/23 5:42 PM EDT
Liam Fitzgerald: This is a fine place for us to talk.
Your Avatar: Do you understand that this telehealth visit is confidential?
Question
04/20/23 5:43 PM EDT
Liam Fitzgerald: Yup, I understand that this visit is private and confidential.
Your Avatar: What brings you here today?
Question
04/20/23 5:44 PM EDT
Liam Fitzgerald: I’m OK, just here for my regular telehealth follow-up.
Your Avatar: When was your last hospital visit?
Question
04/20/23 5:47 PM EDT
Liam Fitzgerald: Six months ago I was in the hospital for my heart failure symptoms.
Your Avatar: When were you diagnosed with heart failure?
Question
04/20/23 5:48 PM EDT
Liam Fitzgerald: I was diagnosed with heart failure two years ago now.
Your Avatar: What symptoms do you currently have?
Question
04/20/23 5:48 PM EDT
Liam Fitzgerald: I don’t really have any symptoms, just here for my follow-up. I’m doing OK.
Your Avatar: Are you using any medications?
Question
04/20/23 5:49 PM EDT
Liam Fitzgerald: My regular heart meds are carvedilol, candesartan, spironolactone, and an aspirin. I have some heart meds that I take as needed too — furosemide, a potassium chloride tablet, and nitroglycerin. For my cholesterol, I take atorvastatin and some fish oil.
Your Avatar: What are the dosages of your medications?
Question
04/20/23 5:50 PM EDT
Liam Fitzgerald: We’re going to have to go down the list since I have regular heart medications, as-needed heart medications, and cholesterol medications.
Your Avatar: What is the dosage of your heart medications?
Question
04/20/23 5:51 PM EDT
Liam Fitzgerald: The carvedilol is 12.5 milligrams, the candesartan is 32 milligrams, the spironolactone is 12.5 milligrams, and the aspirin is an 81 mg EC tablet. And then I take some as-needed heart failure medications.
Your Avatar: What is the dosage of your cholesterol medications?
Question
04/20/23 5:53 PM EDT
Liam Fitzgerald: Hm, let’s see. I take the atorvastatin — it’s 40 mg — and the omega-3 fatty acid fish oil, it’s 1000 mg. I take them both every day.
Your Avatar: What is your medical history?
Question
04/20/23 5:53 PM EDT
Liam Fitzgerald: That’s a long list, let’s see . . . Well, I have heart failure, that’s the big one. And I have coronary artery disease, high blood pressure, high cholesterol, and I had a heart attack a while back.
Your Avatar: When were you diagnosed with coronary artery disease?
Question
04/20/23 5:55 PM EDT
Liam Fitzgerald: I was diagnosed with it five years ago, at the time of my heart attack.
Your Avatar: When were you diagnosed with high blood pressure?
Question
04/20/23 5:55 PM EDT
Liam Fitzgerald: I’ve had high blood pressure for some time now. I was diagnosed at 38 but didn’t try to manage it much. It’s better now though.
Your Avatar: How do you control your blood pressure?
Question
04/20/23 5:56 PM EDT
Liam Fitzgerald: I’m on a few heart medicines, but the carvedilol is the one for blood pressure.
Your Avatar: Any family history of heart problems?
Question
04/20/23 5:57 PM EDT
Liam Fitzgerald: Yeah, heart issues run in the family. Mom’s alive, but she has high blood pressure and high cholesterol. Dad passed at 75 from a heart thing, not sure what it was, and he also had high blood pressure . . . oh, and he had open heart surgery too.
Your Avatar: What is your diet like?
Question
04/20/23 5:58 PM EDT
Liam Fitzgerald: Well, I’m on a low-sodium diet and I try to follow it. For breakfast I have oatmeal with some berries. Lunch is usually some soup, I try to do homemade ones, or some pasta with grilled chicken and vegetables. I’ll have a salad sometimes. Dinner is some fish or grilled chicken with some more vegetables, and some brown rice. If I want a snack, it’s air-popped, no salt popcorn, or an apple with no salt almond butter. It’s not very exciting, but it’s what I need to do.
Your Avatar: Great, a healthy diet is good for your health
Educate
04/20/23 5:58 PM EDT
Liam Fitzgerald: OK, thanks.
Your Avatar: Do you exercise?
Question
04/20/23 5:59 PM EDT
Liam Fitzgerald: Yeah, I exercise regularly. I do tai chi.
Your Avatar: Great, exercise is good for your health
Educate
04/20/23 5:59 PM EDT
Liam Fitzgerald: Got it. Thanks.
Your Avatar: Any allergies?
Question
04/20/23 5:59 PM EDT
Liam Fitzgerald: No, I don’t have allergies.
Your Avatar: Are your immunizations current?
Question
04/20/23 6:00 PM EDT
Liam Fitzgerald: I believe I’m up to date.
Your Avatar: Do you miss doses of your medication?
Question
04/20/23 6:00 PM EDT
Liam Fitzgerald: No. I’m good about taking my medicine.
Your Avatar: Great, it is good to take medications as prescribed
Educate
04/20/23 6:01 PM EDT
Liam Fitzgerald: Gotcha.
Your Avatar: Have you ever had a heart attack?
Question
04/20/23 6:01 PM EDT
Liam Fitzgerald: Yes, I have had a heart attack.
Your Avatar: When did you last have a heart attack?
Question
04/20/23 6:02 PM EDT
Liam Fitzgerald: My heart attack was five years ago.
Your Avatar: What are the symptoms of your heart attack?
Question
04/20/23 6:03 PM EDT
Liam Fitzgerald: The main thing I remember was really intense discomfort in my chest.
Your Avatar: Any history of hospitalizations?
Question
04/20/23 6:03 PM EDT
Liam Fitzgerald: I’ve had a few hospital stays. Five years ago I had a heart attack and they did surgery. Two years ago I had
some issues with my heart and went back in, and they diagnosed me with heart failure. Six months ago was the most recent time, my heart again. I wasn’t feeling great, but they took care of me and I was OK.
Your Avatar: How does your heart failure affect you?
Question
04/20/23 6:04 PM EDT
Liam Fitzgerald: It doesn’t, really — it’s asymptomatic most of the time.
Your Avatar: Do you drink?
Question
04/20/23 6:05 PM EDT
Liam Fitzgerald: Yeah, I drink some.
Your Avatar: How often do you drink?
Question
04/20/23 6:05 PM EDT
Liam Fitzgerald: I don’t really drink very often these days, just on special occasions. I used to have one or two beers a night, but I had to cut down after my heart attack. I’ll have that non-alcoholic stuff sometimes, it’s not half bad, but I’d just rather stick with the real thing if I’m going to have a drink.
Your Avatar: Too much alcohol consumption is not good for your health
Educate
04/20/23 6:08 PM EDT
Liam Fitzgerald: Alright then. Thanks.
Your Avatar: Do you smoke?
Question
04/20/23 6:08 PM EDT
Liam Fitzgerald: I used to smoke.
Your Avatar: When did you last smoke?
Question
04/20/23 6:10 PM EDT
Liam Fitzgerald: I quit smoking after my heart attack. I still get cravings though, so I use the nicotine gum.
Your Avatar: Great, smoking is not good for your health
Educate
04/20/23 6:10 PM EDT
Liam Fitzgerald: Ah, I see.
Your Avatar: Have you ever had an EKG test?
Question
04/20/23 6:11 PM EDT
Liam Fitzgerald: Yeah, when I was hospitalized six months ago for heart failure stuff, they did an EKG and an echocardiogram.
Your Avatar: Do you know your blood pressure number?
Question
04/20/23 6:12 PM EDT
Liam Fitzgerald: Today it was 155 over 95. A little higher than normal.
Your Avatar: Have you lost weight?
Question
04/20/23 6:14 PM EDT
Liam Fitzgerald: No, I’ve actually gained some.
Your Avatar: Gaining weight will only worsen your heart problems
Educate
04/20/23 6:15 PM EDT
Liam Fitzgerald: Got it. Thanks.
Your Avatar: How much weight have you gained?
Question
04/20/23 6:16 PM EDT
Liam Fitzgerald: About four or five pounds.
Your Avatar: Any swelling?
Question
04/20/23 6:16 PM EDT
Liam Fitzgerald: Yeah, I have some swelling right now.
Your Avatar: Where is the swelling located?
Question
04/20/23 6:17 PM EDT
Liam Fitzgerald: In my feet and ankles.
Your Avatar: Any chest pain?
Question
04/20/23 6:18 PM EDT
Liam Fitzgerald: No, my chest hasn’t been hurting.
Your Avatar: Any palpitations?
Question
04/20/23 6:19 PM EDT
Liam Fitzgerald: I don’t have any palpitations at all.
Your Avatar: What caused your weight gain?
Question
04/20/23 6:20 PM EDT
Liam Fitzgerald: I don’t know, really.
Your Avatar: Is your appetite fine?
Question
04/20/23 6:20 PM EDT
Liam Fitzgerald: My appetite’s been the same, pretty normal.
Your Avatar: What heart problems do you have?
Question
04/20/23 6:21 PM EDT
Liam Fitzgerald: I have a little swelling right now, if that counts. If you mean what heart conditions I have — I have coronary artery disease, heart failure, high cholesterol, high blood pressure, and I had a heart attack.
Your Avatar: Do you take caffeine?
Question
04/20/23 6:23 PM EDT
Liam Fitzgerald: I drink decaf.
Your Avatar: How often do you exercise?
Question
04/20/23 6:23 PM EDT
Liam Fitzgerald: I do tai chi three times a week.
Your Avatar: Any skin problems?
Question
04/20/23 6:24 PM EDT
Liam Fitzgerald: No, my skin is normal, same as ever.
Your Avatar: Any fatigue?
Question
04/20/23 6:24 PM EDT
Liam Fitzgerald: I’m feeling OK — not tired.
Your Avatar: What is your occupation?
Question
04/20/23 6:25 PM EDT
Liam Fitzgerald: I’m retired now, but I worked as a truck driver for the postal service.
Your Avatar: What is your living situation?
Question
04/20/23 6:25 PM EDT
Liam Fitzgerald: My home environment is good. I live in a one-story house with my daughter Claire, her husband Mark, and my grandson, Callum.
Your Avatar: Any urination issues?
Question
04/20/23 6:26 PM EDT
Liam Fitzgerald: No issues with going to the bathroom, but I do wake up needing to pee at night
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Hi, my name is xx and I will interview you and later examine you
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Greet |
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Hi there.
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Can you hear me?
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Yeah, I can hear you clearly.
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Are you in an appropriate environment for a telehealth visit?
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This is a fine place for us to talk.
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Do you understand that this telehealth visit is confidential?
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Yup, I understand that this visit is private and confidential. [AUDIO COMING SOON]
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What brings you here today?
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I’m OK, just here for my regular telehealth follow-up.
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When was your last hospital visit?
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Six months ago I was in the hospital for my heart failure symptoms.
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When were you diagnosed with heart failure?
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I was diagnosed with heart failure . . . two years ago now.
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What symptoms do you currently have? (Clarified to Do you know what symptoms are you experiencing?.)
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I don’t really have any symptoms, just here for my follow-up. I’m doing OK. (Clarified to if I know what my symptoms are.)
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Are you using any medications?
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My regular heart meds are carvedilol, candesartan, spironolactone, and an aspirin. I have some heart meds that I take as needed too — furosemide, a potassium chloride tablets, and nitroglycerin. For my cholesterol I take atorvastatin and some fish oil.
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What are the dosages of your medications?
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We’re going to have to go down the list since I have regular heart medications, as needed heart medications, and cholesterol medications.
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What is the dosage of your heart medications?
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The carvedilol is 12.5 milligrams, the candesartan is 32 milligrams, the spironolactone is 12.5 milligrams, and the aspirin is an 81 mg EC tablet. And then I take some as needed heart failure medications.
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What is the dosage of your cholesterol medications?
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Hm, let’s see. I take the atorvastatin — it’s 40 mg — and the omega-3 fatty acid fish oil, it’s 1000 mg. I take them both everyday.
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What is your medical history?
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That’s a long list, let’s see . . . Well I have heart failure, that’s the big one. And I have coronary artery disease, high blood pressure, high cholesterol, and I had a heart attack a while back.
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When were you diagnosed with coronary artery disease?
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I was diagnosed with it five years ago, at the time of my heart attack.
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When were you diagnosed with high blood pressure?
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I’ve had high blood pressure for some time now. I was diagnosed at 38 but didn’t try to manage it much. It’s better now though.
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What do you use for your high blood pressure? (Clarified to How do you control your blood pressure?.)
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I’m on a few heart medicines, but the carvedilol is the one for blood pressure. (Clarified to how I control my blood pressure.)
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Any family history pf heart problems?
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Yeah, heart issues run in the family. Mom’s alive, but she has high blood pressure and high cholesterol. Dad passed at 75 from a heart thing, not sure what it was, and he also had high blood pressure . . . oh and he had open heart surgery too.
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What is your diet like? Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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Question |
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Well I’m on a low-sodium diet and I try to follow it. For breakfast I have oatmeal with some berries. Lunch is usually some soup, I try to do homemade ones, or some pasta with grilled chicken and vegetables. I’ll have a salad sometimes. Dinner is some fish or grilled chicken with some more vegetables, and some brown rice. If I want a snack, it’s air popped, no salt popcorn, or an apple with no salt almond butter. It’s not very exciting, but it’s what I need to do.
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Great. healthy diet is good for your health
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Educate |
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OK, thanks.
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Do you exercise?
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Yeah, I exercise regularly. I do tai chi.
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Great. Exercise is good for your health Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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Educate |
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Got it. Thanks.
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Any allergies?
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No, I don’t have allergies.
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Are your immunizations current?
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I believe I’m up to date.
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Have you missed any medications? (Clarified to Do you miss doses of your medication?.)
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No. I’m good about taking my medicine. (Clarified to if I miss doses of my medication.)
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Great, it is good to take medications as prescribed
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Educate |
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Gotcha.
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have you ever had a heart attack?
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Yes, I have had a heart attack.
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When did you last have a heart attack?
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My heart attack was five years ago.
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What are the symptoms of your heart attack?
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The main thing I remember was really intense discomfort in my chest.
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Any history of hospitalizations?
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Question |
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I’ve had a few hospital stays. Five years ago I had a heart attack and they did surgery. Two years ago I had some issues with my heart and went back in and they diagnosed me with heart failure. Six months ago was the most recent time, my heart again. I wasn’t feeling great, but they took care of me and I was OK.
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How have heart problems affected your life? (Clarified to How does your heart failure affect you?.)
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It doesn’t, really — it’s asymptomatic most of the time. (Clarified to how my heart failure affects me.)
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Do you drink?
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Yeah, I drink some.
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How often do you drink?
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I don’t really drink very often these days, just on special occasions. I used to have one or two beers a night, but I had to cut down after my heart attack. I’ll have that non-alcoholic stuff sometimes, it’s not half bad, but I’d just rather stick with the real thing if I’m going to have a drink.
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Too much alcohol consumption is not good for your health
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Educate |
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Alright then. Thanks.
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Do you smoke
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I used to smoke.
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When did you last smoke?
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I quit smoking after my heart attack. I still get cravings though so I use the nicotine gum.
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Great. Smoking is not good for your health
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Educate |
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Ah, I see.
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Have you ever had an EKG test?
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Yeah, when I was hospitalized six months ago for heart failure stuff, they did an EKG and an echocardiogram.
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What is your blood pressure number? (Clarified to Do you know your blood pressure number?.)
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Today it was 155 over 95. A little higher than normal. (Clarified to if I know my blood pressure number.)
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Any weight issues? (Clarified to Have you lost weight?.)
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No, I’ve actually gained some. (Clarified to if I have lost weight.)
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Gaining weight will only worsen your heart problems
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Educate |
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Got it. Thanks.
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How much weight have you gained?
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About four or five pounds.
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Any swelling?
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Yeah, I have some swelling right now.
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Where is the swelling located?
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In my feet and ankles.
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Any chest pain?
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No, my chest hasn’t been hurting.
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Any palpitations?
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I don’t have any palpitations at all.
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What caused our weight gain?
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I don’t know, really.
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Have you been eating more? (Clarified to Is your appetite fine?.)
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My appetite’s been the same, pretty normal. [AUDIO COMING SOON] (Clarified to if my appetite is okay.)
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Do you monitor your heart problems? (Clarified to What heart problems do you have?.) Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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I have a little swelling right now, if that counts. If you mean what heart conditions I have — I have coronary artery disease, heart failure, high cholesterol, high blood pressure, and I had a heart attack. (Clarified to what heart problems I have.)
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Do you take caffeine?
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I drink decaf.
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How often do you exercise?
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I do tai chi three times a week.
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Any skin problems?
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No, my skin is normal, same as ever.
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Any fatigue?
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I’m feeling OK — not tired.
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What is your occupation?
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I’m retired now, but I worked as a truck driver for the postal service.
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What is your living situation?
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My home environment is good. I live in a one-story house with my daughter Claire, her husband Mark, and my grandson, Callum.
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Any urination issues?
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No issues with going to the bathroom, but I do wake up needing to pee at night.
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Any weakness?
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I’m no Thor, but I can still open pickle jars when needed.
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Any breathing problems?
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I haven’t had any issues with my breathing.
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Are you sexually active?
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Yeah, things are just fine in the bedroom with my lady, Susan.
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move the camera so your ankles are visible on the screen
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Sure, hold on, let me move this thing.
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Inspected left ankle: Edema is present on inspection of bilateral ankles without erythema or streaking
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Inspected right ankle: Edema is present on inspection of bilateral ankles without erythema or streaking Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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Exam Action |
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move the camera so your ankles are visible on the screen, press your finger into the inner boney part of the ankle and hold for 1-2 seconds.
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Sure, hold on, let me move this thing.
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Palpated right ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation
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Palpated left ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation
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Hello. I am going to educate you about your medications
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Sounds good.
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maintain normal activity level, bur discontinue exercise if you experience chest pain
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That sounds good. I’ll stop exercising and call the cardiologist if I get symptoms.
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Adhere to a fluid volume restriction of 1.5 L per day
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Will do. I am very good about my fluid restrictions.
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Avoid drinking alcohol
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Alright, I’ll lay off the alcohol.
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Avoid drinking caffeinated beverages
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OK, no caffeine, but is decaf fine?
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No
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Sounds good, I’ll be careful even with decaf.
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Eat lean meat, whole grains, and fresh fruits and vegetables and season your food with spices instead of salt
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That’s a smart trick. OK, I’ll do that.
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Ask your provider for a referral to a clinical dietitian
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OK, that’s a good tip.
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Adhere to your low-sodium diet, and pay attention to labels to avoid foods high in sodium
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Sounds good. I’ll avoid those high-sodium foods, but what foods should I look at the labels for again?
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All foods
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Alright, I’ll be careful to read all the labels then.
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After consuming a meal high in sodium, watch for signs and symptoms of a worsening condition and take your diuretic as directed.
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That sounds like a plan . . . but how long should I wait after experiencing symptoms before I take the furosemide and potassium chloride?
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30 minutes
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OK, I’ll watch out for those signs and symptoms carefully.
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Test for swelling by performing a pitting edema test
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I’ll look out for that, then . . . though, how do I know if the swelling is related to my CHF and not something else, like standing for long time?
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Watch out for fatigue
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OK, that’s good to know.
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Look out for signs of fluid overload, like weight gain, fatigue during activity
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I’ll look out for symptoms.
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Go to the hospital if your condition worsens Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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I definitely will.
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Follow up with your cardiologist
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I’ll call my cardiologist if that happens.
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Set a reminder for your medications
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Alright. I’ll let my girlfriend and my daughter know . . . but if I take the medication as needed, how will I know if I need a reminder?
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You girlfriend and daughter can remind you to take your medications
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Thanks, those are good suggestions.
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Take furosemide with the potassium chloride to maintain adequate potassium
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I’ll do that, then.
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Take the furosemide with potassium chloride tablet for edema even if you have minor swelling
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I will!
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Beware of symptoms that indicate worsening condition
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Sounds good. I’ll keep an eye out for when to take those meds.
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Thanks for listening, Goodbye
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Alright. Thank you for your help. Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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