Heart Disease Program Diagnosis

Diagnosis Results for on case 2 at 13:50 Dec 9, 1998

Patient Name:

Patient: PT2 Note: DOB 10/10/1913 Description: progressive dyspnea

• History
  • age: 83 year old
  • sex: female
  • weight: normal
  • dyspnea: on-exertion progressive for 6mo
  • chest-pain: anginal chest-pain on-exertion for 2yr
  • symptoms:
  • known-diagnosis: of hypertension, heart-failure for 2mo until 2mo, paroxysmal-atrial-fibrillation for 2mo until 2mo, hypothyroidism treated and rheumatic-heart-disease
  • therapies: on furosemide, k-suppl, digitalis and diltiazem
• Vital-Signs
  • blood-pressure: 150/60
  • heart-rate: 80
  • resp: 20
  • temp: 98.1
• Physical-Exam
  • appearance: appears in no-acute-distress
  • mental-status: conscious
  • chest: was clear
  • jugular-pulse: shows est-jvp normal
  • auscultation: loud s1, III/VI holosystolic systolic-murmur at the apex and I-II/VI rumble diastolic-murmur at the apex
  • abdomen: normal
  • extremities: normal
• Laboratory-Findings
  • ekg: (1hr): sinus-rhythm and non-specific-st&t-changes
  • blood-chemistry: (1hr): Na: 141 k: 4.3 bun: 27 creat: 0.8 Ca: 9.9
  • cbc: (1hr): hct: 43 wbc: 9.6
• Additional-Laboratory-Findings
  • arrhythmia-monitoring: monitor: sinus-rhythm

BEST DIAGNOSTIC HYPOTHESIS

• ISCHEMIC CARDIOMYOPATHY (caused by CORONARY HEART DISEASE), treated with DIGITALIS as indicated by known diagnosis of heart failure; causing
  • LOW CARDIAC OUTPUT, although fatigue not present; causing
    • TREATED FLUID RETENTION, treated with FUROSEMIDE
• MITRAL REGURGITATION as indicated by known diagnosis of rheumatic heart disease, holosystolic systolic murmur at the apex; causing
  • ATRIAL FIBRILLATION PAROXYSMAL (also caused by MITRAL STENOSIS), treated with DIGITALIS as indicated by known diagnosis of paroxysmal atrial fibrillation
• MITRAL STENOSIS as indicated by known diagnosis of rheumatic heart disease, loud s1, rumble diastolic murmur at the apex, also causes ATRIAL FIBRILLATION PAROXYSMAL, although opening snap not present; causing
  • HIGH LA PRESS, treated with FUROSEMIDE as indicated by TACHYPNEA (R: 20), dyspnea on exertion
• HX HYPERTENSION as indicated by known diagnosis of hypertension
• TREATED HYPOTHYROIDISM as indicated by known diagnosis of hypothyroidism
• CORONARY HEART DISEASE, treated with DILTIAZEM as indicated by anginal chest pain on exertion, causing ISCHEMIC CARDIOMYOPATHY
• DIGITALIS (treating ATRIAL FIBRILLATION PAROXYSMAL ISCHEMIC CARDIOMYOPATHY) as indicated by ekg 1hr: non specific st&t changes, although ATRIAL FIBRILLATION PAROXYSMAL

Explanation of items in other hypotheses:

• HYPERTENSIVE HEART DISEASE as indicated by known diagnosis of hypertension causing (LOW LV SYSTOLIC FUNCTION) (LV HYPERTROPHY)
• LOW LV SYSTOLIC FUNCTION, treated with DIGITALIS as indicated by known diagnosis of heart failure causing (LOW CARDIAC OUTPUT)
• LV HYPERTROPHY (also caused by AORTIC REGURGITATION), although ekg 1hr: no lvh
• AORTIC REGURGITATION as indicated by pulse pressure equivocal, known diagnosis of rheumatic heart disease, also causes LV HYPERTROPHY
• LV DIASTOLIC DYSFUNCTION as indicated by known diagnosis of heart failure, dyspnea on exertion, although fatigue not present causing (LOW CARDIAC OUTPUT)

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

• pulse pressure equivocal and LV HYPERTROPHY explained by AORTIC REGURGITATION.
• ekg 1hr: non specific st&t changes explained by DIGITALIS.
• anginal chest pain on exertion and ISCHEMIC CARDIOMYOPATHY explained by CORONARY HEART DISEASE.
• known diagnosis of hypothyroidism explained by TREATED HYPOTHYROIDISM.
• known diagnosis of hypertension explained by HYPERTENSIVE HEART DISEASE or HX HYPERTENSION.
• dyspnea on exertion explained by LV DIASTOLIC DYSFUNCTION or HIGH LA PRESS.
• TACHYPNEA (R: 20) explained by HIGH LA PRESS.
• loud s1, rumble diastolic murmur at the apex, ATRIAL FIBRILLATION PAROXYSMAL and HIGH LA PRESS explained by MITRAL STENOSIS.
• known diagnosis of paroxysmal atrial fibrillation explained by ATRIAL FIBRILLATION PAROXYSMAL.
• holosystolic systolic murmur at the apex explained by MITRAL REGURGITATION.
• known diagnosis of rheumatic heart disease explained by AORTIC REGURGITATION, MITRAL STENOSIS or MITRAL REGURGITATION.
• known diagnosis of heart failure explained by LV DIASTOLIC DYSFUNCTION, LOW LV SYSTOLIC FUNCTION or ISCHEMIC CARDIOMYOPATHY.
• DILTIAZEM treating CORONARY HEART DISEASE.
• FUROSEMIDE treating HIGH LA PRESS or TREATED FLUID RETENTION.
• DIGITALIS treating LOW LV SYSTOLIC FUNCTION, ATRIAL FIBRILLATION PAROXYSMAL or ISCHEMIC CARDIOMYOPATHY.