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DR. Jeffrey Taylor

Community Cardiologist

25 January 2020

Dear Dr. Taylor

Re: Mr. Thomas Sheffield, aged 73

This is to update the current Condition of Mr thomas Sheffield, who underwent permanent pacemaker placement sencondary to complete heart block requires appropriate management, ongoing care and follow up, following his discharge today.

on 21 January 2020, Mr Sheffield was admitted due to an Syncopal attack, while playing golf. Therefore Electrocardiogram performed which revealed, complete heart block, as well as inducement of medication conformed the diagnosis, as heart rate. Continued shreed between 30-40 heat for minutes. However laboratory investigation and x-ray Chest result showed normal, hence the Cardiologist docided for permanent pacemaker

Post-operatively, Mr Sheffield has good progrosis, able to ambulates. independently Rhythm are stable with paced rhythain at 70 beat per minutes. "Daily dressing changed at post-operative sites wound in healing proiets and no signs of infection was noted. Lifting restrictions less than 10 pounds for a fortnight, and application of rling at affected arm for 3 days were advised. Discharged instruction regarding remote monitoring of "Permanent pacemaker activites, and restrictions, along with settings Conformation by Cardiology nurse as Per Physician order were provided. milde pain was noticed at discharge time, there fore non-harcotic medication was pres cribed.

Mr. sheffield has had history of myocardial infarction Since 2015, Hypertension and dyslipidemia. Subsequently,

managed with asprin, 81 mg, once daily, lisinopril, 10mg once daily, lipitor, 40mg at bed time onece aday and meto prolel, 25mg twice daily, Ibuprofen, 80mg thrice daily as needed.

Based on a afort mentioned circumstances, monitorning of pain level is mandatory, follow up appointement with Cardiologist in 7-10days for inspection the site and blood pressure monitorning would be profernally beneficial for Mr. Sheffield Current Condition. Physiotherapy in 3 weeks. to be started after follow up visit has been done. If you require any further information, please do not hesitate to contact me.

Yours Sincerely

Registered Nurse

Cardiac Unit