Showing posts with label Cardiolog Cases. Show all posts
Showing posts with label Cardiolog Cases. Show all posts
What is the most likely diagnosis? What tests and/or imaging tools could be used to confirm the diagnosis?
A 77-year-old man is brought to the emergency department by his daughter after
he developed weakness in his right upper extremity. She says that he has been sick
for the past two weeks with fever, chills, and night sweats and that he has lost nearly
4.5 kg (10 lb) during that time. He had attributed these symptoms to the fl u, but he
could not move his left arm when he woke this morning. He denies other symptoms.
On further questioning, his general health is good except for poorly controlled
hypertension, and he underwent an aortic valve replacement 2 months ago. Physical
examination is remarkable for upper left hemiplegia, the click of his prosthetic valve,
and the image below on funduscopic exam. Vital signs include a temperature of
38.9°C (102.0 °F), blood pressure of 114/55 mm Hg, and pulse of 115/min.
Read more ...
he developed weakness in his right upper extremity. She says that he has been sick
for the past two weeks with fever, chills, and night sweats and that he has lost nearly
4.5 kg (10 lb) during that time. He had attributed these symptoms to the fl u, but he
could not move his left arm when he woke this morning. He denies other symptoms.
On further questioning, his general health is good except for poorly controlled
hypertension, and he underwent an aortic valve replacement 2 months ago. Physical
examination is remarkable for upper left hemiplegia, the click of his prosthetic valve,
and the image below on funduscopic exam. Vital signs include a temperature of
38.9°C (102.0 °F), blood pressure of 114/55 mm Hg, and pulse of 115/min.
2 minutes ago
What Is Your Diagnosis ? What conditions should be included in the differential diagnosis?
A 60-year-old white man with a history of coronary artery disease, peripheral vascular
disease status post-femoral artery–posterior tibial artery bypass grafting, osteoarthritis,
and a 3-year history of hypertension presents to the clinic for a routine blood pressure
check. He has had no complaints since his last checkup 6 months ago. He is taking
hydrochlorothiazide, metoprolol, lisinopril, diltiazem, pravastatin, and aspirin. Vital
signs include a temperature of 37.0°C (98.6°F), blood pressure of 160/95 mm Hg, pulse
rate of 70/min, and respiratory rate of 10/min. His physical examination is notable for
an abdominal bruit auscultated to the right of midline at the level of the umbilicus.
Laboratory values are as follows:
Sodium: 140 mEq/L
Potassium: 4.1 mEq/L
Chloride: 98 mEq/L
Bicarbonate: 23 mEq/L
BUN: 22 mg/dL
Creatinine: 1.8 mg/dL
Glucose: 110 mg/dL
A magnetic resonance angiogram (MRA) is ordered, and shown in Figure
Read more ...
disease status post-femoral artery–posterior tibial artery bypass grafting, osteoarthritis,
and a 3-year history of hypertension presents to the clinic for a routine blood pressure
check. He has had no complaints since his last checkup 6 months ago. He is taking
hydrochlorothiazide, metoprolol, lisinopril, diltiazem, pravastatin, and aspirin. Vital
signs include a temperature of 37.0°C (98.6°F), blood pressure of 160/95 mm Hg, pulse
rate of 70/min, and respiratory rate of 10/min. His physical examination is notable for
an abdominal bruit auscultated to the right of midline at the level of the umbilicus.
Laboratory values are as follows:
Sodium: 140 mEq/L
Potassium: 4.1 mEq/L
Chloride: 98 mEq/L
Bicarbonate: 23 mEq/L
BUN: 22 mg/dL
Creatinine: 1.8 mg/dL
Glucose: 110 mg/dL
A magnetic resonance angiogram (MRA) is ordered, and shown in Figure
What is the most likely diagnosis?
A 62-year-old man with a history of poorly controlled hypertension comes to the
emergency department complaining of 1 hour of intense pain in his chest. He was
climbing the stairs at home when he felt a sudden, sharp pain in the center of his
chest, and felt light-headed. He still feels light-headed and reports that the pain is a
“stabbing,” 10 out of 10 pain that radiates throughout his chest. He denies any other
medical history, but on further questioning reveals that he smokes one pack of cigarettes
daily and takes his metoprolol only when he feels “sick” or has a headache. Vital signs
include a temperature of 37.0°C (98.6°F), blood pressure of 170/100 mm Hg, pulse
rate of 85/min, and respiratory rate of 15/min. Physical examination shows a welldeveloped,
well-nourished, uncomfortable man with slight diaphoresis. His HEENT
and neck examinations are unremarkable. His lung fi elds are clear to auscultation and
he has good breath sounds bilaterally. His heart has a regular rate and rhythm with
a 2/6 diastolic murmur along the right sternal border. Examination of his extremities
reveals an absent right radial pulse. His abdominal and neurologic examinations are
unremarkable. X-ray of the chest shows clear lung fi elds and a widened mediastinum.
Read more ...
emergency department complaining of 1 hour of intense pain in his chest. He was
climbing the stairs at home when he felt a sudden, sharp pain in the center of his
chest, and felt light-headed. He still feels light-headed and reports that the pain is a
“stabbing,” 10 out of 10 pain that radiates throughout his chest. He denies any other
medical history, but on further questioning reveals that he smokes one pack of cigarettes
daily and takes his metoprolol only when he feels “sick” or has a headache. Vital signs
include a temperature of 37.0°C (98.6°F), blood pressure of 170/100 mm Hg, pulse
rate of 85/min, and respiratory rate of 15/min. Physical examination shows a welldeveloped,
well-nourished, uncomfortable man with slight diaphoresis. His HEENT
and neck examinations are unremarkable. His lung fi elds are clear to auscultation and
he has good breath sounds bilaterally. His heart has a regular rate and rhythm with
a 2/6 diastolic murmur along the right sternal border. Examination of his extremities
reveals an absent right radial pulse. His abdominal and neurologic examinations are
unremarkable. X-ray of the chest shows clear lung fi elds and a widened mediastinum.
What is the most likely diagnosis?What conditions should be included in the differential diagnosis?
A 63-year-old woman with a history of diabetes mellitus and hypertension presents to
the emergency department complaining that she feels short of breath. She reports that
she began having diffi culty breathing over the past week, which has progressed to the
point that she can no longer walk up one fl ight of stairs without feeling short of breath.
She was previously able to walk fi ve blocks before becoming short of breath. She denies
any history of heart or lung disease, cough or hemoptysis, chest pain, swelling of the
extremities, or fever. She takes no medication. Vitals signs include a temperature of
37.0°C (98.6°F), blood pressure of 170/90 mm Hg, pulse rate of 95/min, respiratory
rate of 22/min, and oxygen saturation of 92% on room air. Physical examination reveals
that her lungs have crackles at the bases bilaterally, and her cardiac examination reveals
a point of maximum impulse at the sixth intercostal space at the midaxillary line.
There is no clubbing, cyanosis, or edema of the extremities. X-ray of the chest reveals
perivascular haziness, interstitial edema, and an enlarged cardiac silhouette.
Read more ...
the emergency department complaining that she feels short of breath. She reports that
she began having diffi culty breathing over the past week, which has progressed to the
point that she can no longer walk up one fl ight of stairs without feeling short of breath.
She was previously able to walk fi ve blocks before becoming short of breath. She denies
any history of heart or lung disease, cough or hemoptysis, chest pain, swelling of the
extremities, or fever. She takes no medication. Vitals signs include a temperature of
37.0°C (98.6°F), blood pressure of 170/90 mm Hg, pulse rate of 95/min, respiratory
rate of 22/min, and oxygen saturation of 92% on room air. Physical examination reveals
that her lungs have crackles at the bases bilaterally, and her cardiac examination reveals
a point of maximum impulse at the sixth intercostal space at the midaxillary line.
There is no clubbing, cyanosis, or edema of the extremities. X-ray of the chest reveals
perivascular haziness, interstitial edema, and an enlarged cardiac silhouette.
What is the most likely diagnosis?What conditions should be included in the differential diagnosis?
A 63-year-old woman with a history of diabetes mellitus and hypertension presents to
the emergency department complaining that she feels short of breath. She reports that
she began having diffi culty breathing over the past week, which has progressed to the
point that she can no longer walk up one fl ight of stairs without feeling short of breath.
She was previously able to walk fi ve blocks before becoming short of breath. She denies
any history of heart or lung disease, cough or hemoptysis, chest pain, swelling of the
extremities, or fever. She takes no medication. Vitals signs include a temperature of
37.0°C (98.6°F), blood pressure of 170/90 mm Hg, pulse rate of 95/min, respiratory
rate of 22/min, and oxygen saturation of 92% on room air. Physical examination reveals
that her lungs have crackles at the bases bilaterally, and her cardiac examination reveals
a point of maximum impulse at the sixth intercostal space at the midaxillary line.
There is no clubbing, cyanosis, or edema of the extremities. X-ray of the chest reveals
perivascular haziness, interstitial edema, and an enlarged cardiac silhouette.
Read more ...
the emergency department complaining that she feels short of breath. She reports that
she began having diffi culty breathing over the past week, which has progressed to the
point that she can no longer walk up one fl ight of stairs without feeling short of breath.
She was previously able to walk fi ve blocks before becoming short of breath. She denies
any history of heart or lung disease, cough or hemoptysis, chest pain, swelling of the
extremities, or fever. She takes no medication. Vitals signs include a temperature of
37.0°C (98.6°F), blood pressure of 170/90 mm Hg, pulse rate of 95/min, respiratory
rate of 22/min, and oxygen saturation of 92% on room air. Physical examination reveals
that her lungs have crackles at the bases bilaterally, and her cardiac examination reveals
a point of maximum impulse at the sixth intercostal space at the midaxillary line.
There is no clubbing, cyanosis, or edema of the extremities. X-ray of the chest reveals
perivascular haziness, interstitial edema, and an enlarged cardiac silhouette.
What is your diagnosis ?What Are Other Investigations Of This Patient?
A 25-year-old woman with a history of rheumatic fever in childhood presented with repeated
episodes of respiratory tract infections and shortness of breath. On physical examination the
patient was acyanotic and a diastolic murmur was detected. A CXR (Fig. 20a) was performed as a
preliminary investigation.
Read more ...
episodes of respiratory tract infections and shortness of breath. On physical examination the
patient was acyanotic and a diastolic murmur was detected. A CXR (Fig. 20a) was performed as a
preliminary investigation.
What is your diagnosis? (ANSWERED)
A 36-year-old male with no significant medical history presented
to the ED complaining of 30 minutes of palpitations,
described as a rapid, irregular heart beat. The patient reported
mild shortness of breath and fatigue but denied chest pain,
nausea or sweating. He described several similar episodes
in the past, which had always resolved spontaneously within
two hours. Earlier that day, the patient had exercised strenuously
and did not drink much water afterward. He denied
tobacco, intravenous drugs, cocaine or methamphetamine use,
and drank alcohol only occasionally.
The patient was placed on the cardiac monitor and a 12-lead
ECG was obtained
Read more ...
to the ED complaining of 30 minutes of palpitations,
described as a rapid, irregular heart beat. The patient reported
mild shortness of breath and fatigue but denied chest pain,
nausea or sweating. He described several similar episodes
in the past, which had always resolved spontaneously within
two hours. Earlier that day, the patient had exercised strenuously
and did not drink much water afterward. He denied
tobacco, intravenous drugs, cocaine or methamphetamine use,
and drank alcohol only occasionally.
The patient was placed on the cardiac monitor and a 12-lead
ECG was obtained
Atrial Fibrilation with LBBB and rapid ventricular response.
What Is Your Diagnosis?(ANSWERED)
Right Answer Is: Superior vena cava obstruction syndrome
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diagnosis is infective endocarditis (IE).
Tests :This diagnosis should be made by:
Three blood cultures separated by at least 1 hour from different... See More
venipuncture sites.
Stable patients and those who have received prior antibiotics
should not be treated empirically.
Unstable patients should receive empiric treatment once these
cultures are obtained.
Echocardiography should be done in all patients with moderate
suspicion of IE.
TTE should be attempted fi rst in most cases. TEE should be used
if TTE is nondiagnostic.
ECG baseline should be obtained.
Antibiotic treatment is organism specifi c and usually lasts 4–6 weeks
for native valves and at least 6 weeks for prosthetic valves.