Date:
Patient:
MRN:
Clinician: (Vascular Medicine Specialist, Cardiologist, Nephrologist)
Reason for Visit:
Follow-up for FMD
Review of symptoms and medication adherence
Evaluation of blood pressure control and management
(Optional) Angiogram follow-up (if applicable)
History of Present Illness:
Briefly describe the patient’s current status:
Age at diagnosis and presenting symptoms (renal artery stenosis, renovascular hypertension, headaches, peripheral artery involvement)
Current medications for FMD management (antihypertensives, calcium channel blockers)
History of any interventions (angioplasty, stenting)
Past Medical History:
Include any relevant past medical conditions that may be associated with FMD (hypertension, migraines, atherosclerotic disease)
Family History:
Family history of FMD or other vascular diseases
Social History:
Smoking history (significant risk factor for atherosclerosis)
Diet and exercise habits
Physical Exam:
Vital Signs: Blood pressure (multiple readings in different positions)
Abdominal: Bruit (abnormal sound) over the renal arteries (if present)
Neurological (if presenting with headaches)
Labs:
Renal function tests: Creatinine, glomerular filtration rate (GFR) to assess kidney function.
Electrolytes: Potassium for potential medication side effects.
Urinalysis: To rule out other causes of kidney dysfunction.
Consider mentioning other labs as relevant:
Lipid panel – to assess overall cardiovascular health
Imaging:
Imaging studies may have been performed previously to diagnose FMD:
Renal artery angiogram: Gold standard for diagnosing FMD in the renal arteries.
MRA (Magnetic resonance angiography): Non-invasive alternative for visualizing arteries.
Doppler ultrasound: May be used for initial evaluation or follow-up.
Consider mentioning any recent imaging results and their interpretation.
Assessment:
Confirm the diagnosis of FMD based on clinical presentation, imaging studies, and response to treatment.
Assess the severity of FMD and its impact on organ function (e.g., kidney function in renal artery stenosis).
Evaluate blood pressure control and response to medications.
Plan:
Outline the treatment plan based on the severity of FMD and blood pressure control:
Lifestyle modifications: Smoking cessation, healthy diet, exercise for overall cardiovascular health.
Medications: Antihypertensives (calcium channel blockers are often preferred), medications to manage specific symptoms (headaches).
Minimally invasive interventions: Angioplasty or stenting of narrowed arteries (if indicated and appropriate for the patient).
Prognosis:
Briefly discuss the prognosis. Early diagnosis and treatment can help prevent complications like kidney failure or stroke. FMD is a chronic condition requiring long-term management.
Education:
Document any education provided to the patient regarding:
The nature of FMD and its potential complications
Importance of medication adherence and regular follow-up
Healthy lifestyle modifications to manage FMD and cardiovascular health
The potential need for future interventions
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the condition and any concerns they may have.
Consider mentioning the importance of monitoring for symptoms of worsening FMD or medication side effects.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a healthcare professional for diagnosis and treatment recommendations.