Day 13 Case Notes Analysis

This case notes will be used for writing today’s letters for correction. Before you proceed to writing this letter on the writing page, please read this case notes and answer the questions that below:



Read the case notes below and complete the writing task which follows.


Mr Leam H Marvel (78 years) has had septal myectomy three days ago at General Hospital. He sustains complications. At present he is being prepared for alcohol septal ablation at another hospital.

  • Date: Today’s date

Patient Information

  • Mr Leam H Marvel, 78 years
  • Overweight, smokes excessively, occasionally drinks
  • Mild Sleep disorders; used sleeping pills till 2015
  • Lives in Sydney with wife; servant, helped and advised by neighbor Ms Simran (nurse); Son Henry mostly away from Sydney (greatly concerned; phone number: +61 3345 57356)
  • Address: Baskerville Estate, Asphalt Lane, Sydney

Post Septal myectomy

  • Feels confused
  • No symptom relief
  • Heart rate has not improved
  • Refuses to talk (tube still on)
  • Bandages on incision
  • Feels soreness, but no severe pain.
  • Can sit in a chair and walk with help.
  • Drinks liquids.
  • Wears elastic stockings.

Medical History

  • Mildly asthmatic (high during winters)
  • Slightly obese
  • Recovered from Covid19 on 15th May, 2020
  • Hypertrophic cardiomyopathy diagnosed on 12th January, 2020
  • On medication for a month (Beta blockers)
  • (Conditionally) Good candidate for alcohol septal ablation.
  • Chest X-ray: Normal
  • Blood tests: Normal
  • Echocardiogram: Slightly larger heart size (keeps changing)


  • Alcohol septal ablation on the 4th day from surgery.
  • Mrs Marvel and son Henry wish to understand more about the possible risks after alcohol septal ablation (They don’t seem to be convinced after a telephonic conference today)

Irregular heart rhythms, such as heart block; Infection; bleeding; blood clots leading to stroke or heart attack; complications from anesthesia; aortic valve problems due to movement of the valve in surgery; removal of too much heart muscle; blood flow problems during surgery that can lead to poor pumping function of the heart in the future

Writing Task

Using the information in the case notes, write a letter to Dr Roger Flemingway, Hearty Care, 6567, Green Park Avenue, Sydney, detailing Mr Marvel’s recent medical history and the course of the surgery. You are Ms Manpreet Caur, General Hospital, Charcoal Street, Sydney.

In your answer:

  • Expand the relevant notes into complete sentences
  • Do not use note form
  • Use letter format
  • The body of the letter should be approximately 180–200 words.

Now take this Case Notes Analysis and proceed to Letter Writing

  • Question of

    Who is the patient?

    • An elderly man who has undergone a successful surgery
    • An elderly man who has undergone an unsuccessful surgery
    • An elderly man who is going to undergo a surgery
  • Question of

    Who is the recipient?

    • A doctor
    • A team of doctors and nurses
    • A team of doctors
  • Question of

    Is the patient known to the recipient?

    • Yes
    • No
  • Question of

    What is the admission / discharge status:

    • Discharged
    • Admitted but discharge not planned
    • Being discharged today
  • Question of

    What is the purpose of this letter?

    • Transfer the patient to another hospital for another surgery
    • Transfer the patient to another hospital for another process
    • Transfer the patient to another hospital postoperative care
  • Question of

    What is the least relevant information to be passed?

    • Risks of alcohol septal ablation
    • Social history
    • Post Septal myectomy details
  • Question of

    Why is the patient referred for alcohol septal ablation?

    • septal myectomy was not performed
    • The patient was found better candidate for alcohol septal ablation
    • Septal myectomy failed

Written by Biju John

Love for English begins with understanding its unknown rules. Biju John lives on the internet, teaching OET, IELTS and PTE. More than a million students have thanked him from their heart.

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  1. 17 June,2020

    Dr Roger Flemingway
    Hearty Care
    6567,Green Park Avenue

    Dear Dr Flemingway,

    Re : Mr Leam H Marvel,78 years

    I am writing to introduce Mr Marvel who has been sustained complications following septal myectomy.His family requires further understanding about the possible risks of alcohol septal ablation.Currently,he is being prepared for the above mentioned surgery.

    Post-operatively,Mr Marvel was found to be confused and reluctant to talk. Although he is free from pain,he still experiences persistent symptoms including irregular heart rhythms.At present,he is able to sit in a chair and ambulate with help.

    Mr Marvel lives with his wife and they have a son,Henry who is more concerned about his father’s health.Mr Marvel consumes alcohol occasionally and smokes in excess.In Terms of his medical history, he has had hypertrophic cardiomyopathy since January 2020 and is being managed with beta blockers. He is mildly asthmatic and has been recovered from covid-19 recently.Please note,his current body weight is above than the recommended level.

    In view of the above,it would be greatly appreciated if you could see Mr Marvel’s family and provide information regarding post-operative complications as they seem not convinced well after a telephonic talk with me today.

    Kindly contact me for further queries.

    Yours sincerely,

    Ms Manpreet Caur

  2. 18 June 2020

    Dr Roger Flemingway
    Heart Care,6567
    Green Park Avenue

    Re: Mr Leam H Marval, Age: 78 years

    Dear Dr Flemingway

    I am writing regarding Mr Marval, who is posted for an alcohol septal ablation procedure due to owing complications of his recent surgery. He is being referred and now requires assessment and appropriate management.

    Mr Marval underwent septal myectomy.Post-operatively, he has not attained good recovery. He has been experiencing confusion and soreness, which resulted in him having unstable heart rate. Although he refused to communicate, he is able to sitting in a chair as well as walk with help. He is tolerating liquid diet and wearing elastic stockings.

    Mr Marval smokes excessively and drinks occasionally. In terms of medical background, he has had mild sleep disorder and as a result, he has used sleeping pills. He has had hypertrophic cardiomyopathy since 2020 and as a result, he has been prescribed beta blockers. He has had asthmatic effects during winters. Please be aware that he was recovered from Covid 19.

    In view of the above, it would be greatly appreciated if you could assess Mr Marval and provide deemed management. Both Mrs Marval and his son have been explained regarding possible complications of surgery.

    If you have any queries please do not hesitate to contact me.

    Yours sincerely
    Ms Manpreet Caur

Day 12 Paragraph Labeling

Day 13 Pronouns Advanced