Date:
Patient:
Reason for Visit:
Follow-up for known PAVM
Evaluation of symptoms (e.g., dyspnea, hemoptysis, platypnea, clubbing)
Assessment of treatment response and potential complications
History:
Present Illness:
Onset, duration, and severity of symptoms suggestive of PAVM:
Dyspnea (shortness of breath) – may be progressive or exertional
Hemoptysis (coughing up blood) – can be life-threatening
Platypnea (worsening of shortness of breath when lying flat)
Clubbing (enlarged and rounded fingertips)
Functional limitations due to symptoms
Past Medical History (PMH):
Underlying conditions associated with PAVM (e.g., hereditary hemorrhagic telangiectasia (HHT))
Prior interventions for PAVM (embolization, surgery)
Social History:
Smoking history (can worsen PAVM symptoms)
Occupational exposures (塵埃 chén’ēi – dust, fumes)
Physical Exam:
Vital Signs: Assess for tachypnea (rapid breathing) and hypoxia (low oxygen levels)
Cardiovascular:
Listen for heart murmurs suggestive of increased blood flow through the PAVM
Assess for jugular venous distention (increased pressure in the jugular veins)
Pulmonary:
Auscultate for breath sounds (presence of crackles)
Diagnostic Tests (may be ordered depending on clinical presentation):
Chest X-ray: May show signs of enlarged pulmonary arteries.
Chest CT scan with contrast: The gold standard for diagnosing PAVMs, showing abnormal connections between arteries and veins.
Echocardiogram: May show signs of right ventricular strain from increased blood flow.
Pulmonary angiography: Visualization of pulmonary arteries and veins, used for complex cases or pre-intervention planning.
Assessment:
Confirmation of PAVM: Based on clinical presentation, imaging studies, and angiography (if performed).
PAVM size and location: Important for determining treatment approach.
Degree of shunting: The amount of blood bypassing the capillaries in the lungs.
Presence of complications: Brain abscess, high-output heart failure
Plan:
Treatment plan based on PAVM characteristics, symptoms, and patient factors:
Observation: For asymptomatic PAVMs or those with minimal shunting.
Embolization: Minimally invasive procedure to block the abnormal connection using coils or plugs.
Surgery: For large or complex PAVMs, may involve resection (removal) of the malformation.
Medications: Supplemental oxygen for severe hypoxemia
Referral to a cardiothoracic surgeon or interventional radiologist: For complex cases or consideration of embolization/surgery.
Patient education: Provide information about PAVM, potential complications, importance of regular follow-up, and signs and symptoms to watch for.
Smoking cessation education and support
Follow-up:
Schedule for regular follow-up appointments to monitor symptoms, perform imaging studies to assess for changes, and discuss the need for intervention.
Discuss the importance of long-term management, as PAVMs are chronic conditions.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pulmonary arteriovenous malformations.