Heart Disease Program Diagnosis

Diagnosis Results for on case 1 at 13:51 Dec 9, 1998

Patient Name:

Patient: PT1 Note: DOB 10/2/25 Description: syncope

• History
  • age: 70 year old
  • sex: male
  • weight: normal
  • dyspnea: no
  • chest-pain: no
  • symptoms: syncope/near-syncope on-exertion without-injury and fatigue for 1wk
  • therapies: on furosemide for 1yr
• Vital-Signs
  • blood-pressure: 150/105
  • heart-rate: 80
  • resp: 18
  • temp: 100.0
• Physical-Exam
  • appearance: appears in no-acute-distress
  • jugular-pulse: normal
  • pulse: has slow-rise
  • auscultation: III/VI ejection systolic-murmur at the 2ri also at the neck
  • extremities: mild pedal-edema
• Laboratory-Findings
  • ekg: (now): lv-strain and ventricular-rate
  • cxr: (now): wnl

BEST DIAGNOSTIC HYPOTHESIS

• AORTIC STENOSIS as indicated by pulse has slow rise, ejection systolic murmur at the 2ri, syncope/near syncope on exertion, ekg now: lv strain, although ekg now: no block, normal a2 s2, dyspnea on exertion not present, known diagnosis of hx rheumatic fever not present
• NONPULMONARY INFECTION as indicated by fatigue, FEVER (T: 100.0), TACHYPNEA (R: 18)
• HYPERTENSION as indicated by HIGH BLOOD PRESS (bp: 150/105), ekg now: lv strain, HIGH SYSTEMIC VASCULAR RESISTANCE (svr: possibly high), although loud s2a not present
• Unaccounted findings: mild pedal edema, FUROSEMIDE.

Explanation of items in other hypotheses:

• ISCHEMIC CARDIOMYOPATHY (possibly caused by CORONARY HEART DISEASE) causing (LOW CARDIAC OUTPUT)
• LOW CARDIAC OUTPUT causing (TREATED FLUID RETENTION)
• TREATED FLUID RETENTION, treated with FUROSEMIDE as indicated by mild pedal edema
• CORONARY HEART DISEASE as indicated by causing ISCHEMIC CARDIOMYOPATHY, although anginal chest pain no chest pain history
• ENDOCARDITIS (caused by AORTIC STENOSIS) as indicated by fatigue, FEVER (T: 100.0), TACHYPNEA (R: 18), although SEPTIC SHOCK is false
• PULMONARY EMBOLISM (caused by LOW CARDIAC OUTPUT) as indicated by TACHYPNEA (R: 18)
• MYOCARDIAL INFARCTION ACUTE (caused by CORONARY ARTERY DISEASE) as indicated by FEVER (T: 100.0), TACHYPNEA (R: 18), although diaphoresis not present, anginal chest pain no chest pain causing (HIGH BLOOD PRESS (bp: 150/105))
• HIGH BLOOD PRESS (bp: 150/105) as indicated by HIGH SYSTEMIC VASCULAR RESISTANCE (svr: possibly high), although loud s2a not present
• CORONARY ARTERY DISEASE as indicated by causing MYOCARDIAL INFARCTION ACUTE, although anginal chest pain no chest pain history
• PERICARDITIS as indicated by fatigue, FEVER (T: 100.0), TACHYPNEA (R: 18), although ekg now: no st changes
• ANXIETY, although appears anxious not present, diaphoresis not present, HIGH HEART RATE ABSENT (hr: 80) causing (HIGH BLOOD PRESS (bp: 150/105))

The findings (lower case) are explained by the hypotheses as follows:

• MYOCARDIAL INFARCTION ACUTE explained by CORONARY ARTERY DISEASE.
• PULMONARY EMBOLISM explained by LOW CARDIAC OUTPUT.
• ISCHEMIC CARDIOMYOPATHY explained by CORONARY HEART DISEASE.
• mild pedal edema explained by TREATED FLUID RETENTION or unaccounted.
• HIGH SYSTEMIC VASCULAR RESISTANCE (svr: possibly high) explained by HIGH BLOOD PRESS (bp: 150/105) or HYPERTENSION.
• HIGH BLOOD PRESS (bp: 150/105) explained by HYPERTENSION.
• TACHYPNEA (R: 18) explained by PERICARDITIS, MYOCARDIAL INFARCTION ACUTE, PULMONARY EMBOLISM, ENDOCARDITIS or NONPULMONARY INFECTION.
• FEVER (T: 100.0) explained by PERICARDITIS, MYOCARDIAL INFARCTION ACUTE, ENDOCARDITIS or NONPULMONARY INFECTION.
• fatigue explained by PERICARDITIS, AORTIC STENOSIS, ENDOCARDITIS or NONPULMONARY INFECTION.
• ekg now: lv strain explained by HYPERTENSION or AORTIC STENOSIS.
• pulse has slow rise, ejection systolic murmur at the 2ri, syncope/near syncope on exertion and ENDOCARDITIS explained by AORTIC STENOSIS.
• FUROSEMIDE treating TREATED FLUID RETENTION or unaccounted.