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Case Study Analysis

Case Study Analysis. Chris Kwan PBL 28. Investigation - ECG. Investigation - Echo. Presentation. Mr Fafnir Dryke , aged 49, presents into your clinic His presenting complaints include: Dyspnoea Chest pain Faintness Bruises on his arm and face Swollen R. knee, walks in with a limp.

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Case Study Analysis

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  1. Case Study Analysis Chris Kwan PBL 28

  2. Investigation - ECG

  3. Investigation - Echo

  4. Presentation • MrFafnirDryke, aged 49, presents into your clinic • His presenting complaints include: • Dyspnoea • Chest pain • Faintness • Bruises on his arm and face • Swollen R. knee, walks in with a limp

  5. Explanation of Symptoms • Dyspnoea: • On exertion, O2 demands increase  exertionaldyspnoea • Chest pain: • Similar pain as in MI and other ACS • Aortic stenosis LV hypertrophy but coronary arteries do not always supply all of the tissue  ischaemia • Also, O2 demands increase especially on exertion  worsens ischaemia • Will show signs of ventricular strain on ECG (i.e. STEMI signs on ECG) • Syncope: • On exertion, O2 demands increase  inadequate O2 perfusion to brain  syncope

  6. Explanation of Examination Findings • Anacrotic carotid pulse • Small volume, slow uptake; peak delayed towards S2 • Due to reduced outflow of blood • Displaced apex beat (to the left) • AS induces LV hypertrophy  apex felt towards left • Aortic Murmur • S4: occurs just before S1 (when mitral and tricuspid valves close) • S4 occurs in the presence of forceful atrial contraction that causes ventricular vibration • LA needs to be very forceful since LV is hypertrophied • Often can hear at carotid artery

  7. Justification for Investigations • ECG • Need to establish if the patient has MI, arrhythmias etc • Can also find associated heart pathologies (e.g. left axis deviation as in LV hypertrophy) • Echo • Can map out blood flow and find valvular pathologies

  8. Possible DDx for this Case • Acute Coronary Syndromes • Any arrhythmias (e.g. AF, VT) • Any valvular disorder (esp. mitral and aortic regurgitation) • Aortic dissection • PE • Corpulmonale (RV enlargement due to chronic pulmonary disease) • (Not an exhaustive list!)

  9. References • http://www.sage-hindawi.com/journals/crp/2010/423465/ • Talley and o’Connor • Bates’ Guide to Physical Examination

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