Heart Disease Program Diagnosis

Diagnosis Results for on case 5 at 13:47 Dec 9, 1998

Patient Name:

Patient: PT5 Note: DOB 10/10/1943 Description: angina at rest

• History
  • age: 53 year old
  • sex: female
  • weight: normal
  • chest-pain: anginal chest-pain at-rest present
  • symptoms: nausea/vomiting
  • known-diagnosis: of hypertension, copd and diabetes
  • therapies: on beta-blocker, nitroglycerin, ace-inhibitor and digitalis
• Vital-Signs
  • blood-pressure: 140/86
  • heart-rate: 80
  • resp: 16
  • temp: 97.6
• Physical-Exam
  • appearance: appears in no-acute-distress
  • mental-status: conscious
  • chest: revealed decreased-breath-sounds
  • jugular-pulse: normal
  • pulse: normal
  • auscultation: s1, s2, s3 and I-II/VI ejection systolic-murmur at the lsb also at the left-axilla
  • abdomen: normal
  • extremities: normal
• Laboratory-Findings
  • ekg: (1hr): acute anterior infarct and lateral ischemia
  • cbc: (1day): hct: 40 wbc: 10.1
  • cardiac-enzymes: increased-cpk-mb (1hr)
• Additional-Laboratory-Findings
  • left-heart-cath: lf cath (6mo): EF: 30 and MR 2+
  • echocardiography: (6mo): lv-enlargement, MR 2+ and EF: 30

BEST DIAGNOSTIC HYPOTHESIS

• MITRAL REGURGITATION (caused by LOW LV SYSTOLIC FUNCTION) as indicated by echocardiography 6mo: MR, left heart cath 6mo: MR, ejection systolic murmur at the lsb, although la enlarge not present
• MYOCARDIAL INFARCTION ACUTE (caused by CORONARY ARTERY DISEASE), treated with NITROGLYCERIN as indicated by increased cpk mb, ekg 1hr: lateral ischemia, anginal chest pain at rest, EKG: acute infarct, nausea/vomiting, wbc 1day: 10.1, although diaphoresis not present
• HYPERTENSIVE HEART DISEASE as indicated by known diagnosis of hypertension; causing
  • LOW LV SYSTOLIC FUNCTION, treated with DIGITALIS, treated with ACE INHIBITOR as indicated by causing MITRAL REGURGITATION, depressed ef, lv enlarge, s3
  • LV HYPERTROPHY, although ekg 1hr: no lvh
• COPD (known diagnosis) as indicated by chest revealed decreased breath sounds, TACHYPNEA (R: 16), although cough not present, chest revealed wheezes not present
• CORONARY ARTERY DISEASE, treated with BETA BLOCKER as indicated by causing MYOCARDIAL INFARCTION ACUTE

Explanation of items in other hypotheses:

• DILATED CARDIOMYOPATHY, treated with DIGITALIS, treated with ACE INHIBITOR as indicated by causing MITRAL REGURGITATION, depressed ef, lv enlarge, s3
• HX HYPERTENSION as indicated by known diagnosis of hypertension

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

• MYOCARDIAL INFARCTION ACUTE explained by CORONARY ARTERY DISEASE.
• COPD explained by known diagnosis.
• chest revealed decreased breath sounds and TACHYPNEA (R: 16) explained by COPD.
• MITRAL REGURGITATION, depressed ef, lv enlarge and s3 explained by DILATED CARDIOMYOPATHY or LOW LV SYSTOLIC FUNCTION.
• known diagnosis of hypertension explained by HX HYPERTENSION or HYPERTENSIVE HEART DISEASE.
• increased cpk mb, ekg 1hr: lateral ischemia, anginal chest pain at rest, EKG: acute infarct, nausea/vomiting and wbc 1day: 10.1 explained by MYOCARDIAL INFARCTION ACUTE.
• echocardiography 6mo: MR, left heart cath 6mo: MR and ejection systolic murmur at the lsb explained by MITRAL REGURGITATION.
• BETA BLOCKER treating CORONARY ARTERY DISEASE.
• DIGITALIS and ACE INHIBITOR treating DILATED CARDIOMYOPATHY or LOW LV SYSTOLIC FUNCTION.
• NITROGLYCERIN treating MYOCARDIAL INFARCTION ACUTE.