miky
Forum Senior
Topics: 16
Posts: 99
|
55 yo male
History:
heavy smoker (20 cigs/day for 20 yrs),
chronic stable angina,
NIDDM
Come to you with moderate abdominal pain of recent onset, severe dizziness and shortness of breath and blood in the stools.
Physical:
the pt. is very agitated.
BP = 95/65 supine, 70/50 orthostatism
HR = 180
RR = 30
systolic murmur best heard at the apex
distended neck veins
bilateral lung rales
generalized palor; cool extremities
diffuse abdominal tenderness, voluntary guarding, mildly distended abdomen
DRE: blood-streaked stools
Lab:
pH = 7.12,
SaO2 = 88%
ECG: supradenivelated ST segment in precordial leads, irregular rhythm
CXR: enlarged heart silhouette, blunted costovertebral angles, bilateral upper lobe infiltrates
The next logical investigation is 8) :
The most probable dx is  : (be very careful)
___________________
always happy and ready to serve and help my friends and patients as well.
|
| deea
Forum Newbie
Topics: 5
Posts: 32
|
The patient is a NIDDM - so he had a silent myocardial infarction (probably anterior) some hour before, then he developed atrial fibrillation or an intraventricular thrombus - the trombus embolised into a mesenteric artery producing a intestinal infarction (thus the blood in his stool)
The next investigation (this is always my weak point :roll: ) - probably some cardiac enzymes to confirm the AMI and/or abdominal XR
|
| miky
Forum Senior
Topics: 16
Posts: 99
|
WELL DONE Deea!!!!!!!!!!!!!!
CONGRATULATIONS !!!!!!!!!!!!!!!!!!
Yes, the pt has MI and intestinal ischemia, probably secondary to chronic AF
There is still one aspect you did not notice - the patient is in shock - so the pt. has cardiogenic shock
The next investigation is ECHO - to see the ejection fraction
Also try to get the cardiac enzymes. Although not very useful right now.
Then ask an angigraphy = gold standard dx for ischemia
Treatment: O2, Morphine (also for pulmonary edema - present in this pt.), vasopressor drugs / Digoxin, depending on what you fing on ECHO
Ganz catheter - monitor fluid status
___________________
always happy and ready to serve and help my friends and patients as well.
|
|
| |
| | | |
