Dialated Cardiomyopathy Case Studies

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is

The beneficiary was an 82 year old man who had a history of multiple health problems, including chest pain, coronary artery disease, elevated cholesterol, high blood pressure, diabetes, chronic kidney disease, and obesity. In 2014 he underwent a cardiac catheterization and the repair of an abdominal aortic aneurism.

A 49 year old Afro-Cuban male with a history of chronic alcoholism and hypertension presented with a three day history of fever (106ᵒ F), change in mental status, and body aches in August, 2016. On admission, he was febrile 103.1ᵒ F, with a heart rate of 137 beats per minutes, blood pressure of 156/79 mm of Hg, and respiration rate of 32 breaths per minute. The patient’s laboratory results on admission included white cell count 9.2 x 103/microL, platelets 71 x 103/microL , PT 28 seconds, PTT 43 seconds, INR 2.62, albumin 3.1, Tblb (total bilirubin) 13.6 mg/dl , AST (aspartate transaminase) 133, and ALT (alanine transaminase) 56. Lactic acid was 6.2 mmol/L, and blood alcohol level checked the next day was less than 10 mg/dl. In addition, he

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

shortness of breath. Pain improved with sublingual Nitroglycerine and Aspirin given by EMS. On arrival to ED his blood pressure was 154/94, HR 70 bpm, RR 19 and SpO2 98% in room air. Heart, lung, abdominal and neurological examinations were unremarkable.

Temperature is 97.2, pulse 84, respirations 14, blood pressure is 112/62, height 74 inches, weight 156 pounds, sating at 99% on room air. Generally, this is a thin man sitting comfortably in no acute distress. Skin is warm and dry. HEENT: Head: Normocephalic, atraumatic. Pupils equal, reactive to light and accommodation. Sclerae is anicteric. Oral mucosa is moist without lesions. No JVD. No thyromegaly. Lymphatics: No cervical, supraclavicular, axillary or inguinal adenopathy appreciated. Respiratory: Lungs are clear to auscultation bilaterally. Heart: Regular rate and rhythm. Abdomen: Soft, nontender. Positive bowel sounds. Liver and spleen not palpable. Strength is 5/5 throughout. Neurological exam is intact.

Data gathered tonight includes electrocardiogram is unchanged from previous showing slightly low voltage, left anterior fascicular block. No definite ischemic changes. White count of 6.2, hemoglobin 11.00, platelets 117, glucose 90, BUN 43, creatinine 2.56, sodium of 138, potassium of 3.4, chloride 106, CO2 of 24.8, calcium of 8.2, bilirubin 0.92, alkaline phosphatase 307, ALT of 23, AST of 21, magnesium of 1.8, a troponin is 0.06, BNP is 2650. Labs done almost 24 hours ago had a lower BUN at 41, and a lower creatinine 2.23, a higher potassium at 3.7, BNP that was higher earlier at 3350, and a troponin that was slightly less at 0.04. Chest x-ray may have more congestion now than previous. Frontal view this morning was obtained the radiologist says the findings are concerning for minimal congestion versus atelectasis in lung bases and a stable mild to moderate cardiac

At today’s visit the patient is awake, alert and oriented. He reports that he has loss 8 lbs recently. He has a poor appetite and has not been taking his megace. He reports generalized neoplasm pain, which he describes as aching with a severity of 4/10. He reports that his pain does not radiate and there are no aggravating factors. He reports that his pain is manage with his current pain regimen of

Patients presenting Symptoms: Gradual onset of dyspnea on exertion, fatigue, frequent dyspepsia with nausea and occasional epigastric pain, trouble breathing while lying on his back and, which is relieved by sitting up (orthopnea), an hypertension.

Stem cells have made significant promise to help people understand and treat a broad range of injuries, diseases, and other health-related issues. This type of treatment has saved the lives of many people with leukemia and can also be used for tissue grafts to treat conditions with the skin, bone and surface of the eye ("Nine Things to Know about Stem Cell Treatments"). Dilated cardiomyopathy (DMC) is a disease characterized by expansion of the left ventricular chamber and it is usually associated with systolic dysfunction. The presentations of the condition include heart failure, myocardial infarction, and arrhythmia and as a refractory life-threatening condition which can cause heart failure, transplantation remains the ultimate therapy for

HCM happens when the heart muscle enlarges and thickens without an obvious cause. Usually the ventricles, the lower chambers of the heart, and septum thicken. The thickened areas create narrowing or blockages in the ventricles, making it harder for the heart to pump blood; however, in very few instances the heart actually contracts with much greater force causing an obstruction to the blood flow (CMUK, 2015). HCM also can cause stiffness of the ventricles, changes in the mitral valve, and cellular changes in the heart tissue.

A 54 year old female with a history of ischemic cardiomyopathy with stage D heart failure requiring home milrinone therapy. She presented to our hospital with progressive shortness of breath, orthopnea, and pitting lower extremity edema despite home milrinone. She was admitted to the cardiac intensive care unit where LVAD work-up was initiated. She was deemed an appropriate candidate for an LVAD placement and had the HeartMate II LVAD placed. Aside from one episode of atrial fibrillation with rapid ventricular response her postoperative course was uneventful. She was anti-coagulated and taken off milrinone postoperatively. Two weeks after her procedure, she started to complain of difficulty opening her eyes, double vision, she had no weakness

A 67-year-old male presents to the emergency department with a 2-day history of fever and productive cough. He feels very unwell. The patient is known to have multiple myeloma, a diagnosis established 1 year ago. He was induced with high-dose chemotherapy and maintained on bortezomib. Vital signs: Temperature 38.8ºC (101.8°F), blood pressure 125/88 mmHg, heart rate 98 beats/min, respiratory rate 20 breaths/min. Crepitations are heard in the right middle chest. Chest x-ray shows areas of consolidation in the right middle and lower lobes. They most recent serum protein electrophoresis is seen in the image. The M-spike has increased from 4.5 to 6.3 gm/dL over the past 4 months. The most likely predisposing cause of the patent’s findings is: