Wiki HPI elements - mitral valve replacement

[HOWRU2DAY]

I am having trouble picking out the elements of HPI in this type of note. I would appreciate some input.


General Pt has hx of MI with single vessel bypass and mitral valve replacement, bl dvts previously on coumadin. Underwent bypass of RCA with right saphenous vein. had ruptured mitral valve with chf replaced and did not take returned to OR and had a blood clot seen removed and valve fixed. Had SIRS in hospital with kidney and liver failure and respiratory failure. DVTs in both calf muscles was on coumadin for a while and stopped when went to rehab. finished rehab Walking at home daily Denies cp, no sob. . No pnd or orthopnea. . FU US for dvts showed no venous thrombosis. Seen by cardiology agreed no need for anticoagulation with porcine valve. .

 

[rda23@aol.com]

I'll try

You always need more detail, but here goes ...

LOCATION: What we're looking for here are symptoms of Deep Vein Thrombosis, which previously had manifested in the calves.
QUALITY: n/a
SEVERITY: Patient denies chest pain and shortage of breath.
DURATION: Unclear from this narrative, but as this appears to be a follow-up, accessible in records if needed, or may be included with the Personal History
TIMING: n/a
CONTEXT: n/a
MODIFYING FACTORS: History of successful treatment with Coumadin; previous clotting in heart
ASSOCIATED SIGNS/SYMPTOMS: Now walking daily.

It's tricky because a couple of these things aren't symptoms, but remain relevant as follow-up data for a life-threatening sequence of events.