Download Read the Case Study from “Introduction to Medical Terminology

Read the Case Study from “Introduction to Medical
Terminology” from Chapter 9 and answer the questions
that follow.
Case Study 9-1: PTCA and Echocardiogram
A.L., a 68-year-old woman, was admitted to the CCU with chest pain, dyspnea, diaphoresis, syncope, and
nausea. She had taken three sublingual doses of nitroglycerine tablets within a 10-minute time span without
relief before dialing 911. A previous stress test and thallium uptake scan suggested car- diac disease.
Her family history was significant for cardiovascular disease. Her father died at the age of 62 of an acute
myocardial infarction. Her mother had bilateral carotid endarterectomies and a femoral-popliteal bypass
procedure and died at the age of 72 of congestive heart failure. A.L.’s older sister died from a ruptured
aortic aneurysm at the age of 65. Her ECG on admission presented tachycardia with a rate of 126 bpm with
inverted T waves. A murmur was heard at S1. Her skin color was dusky to cyanotic on her lips and
fingertips. Her admitting diagnosis was possible coronary artery disease, acute myocardial infarction, and
valvular disease.
Cardiac catheterization with balloon angioplasty (PTCA) was performed the next day. Significant stenosis
of the left anterior descending coronary artery was shown and was treated with angioplasty and stent
placement. Left ventricular function was normal.
Echocardiogram, 2 days later, showed normal-sized left and enlarged right ventricular cavities. The mitral
valve had normal amplitude of motion. The anterior and posterior leaflets moved in op- posite directions
during diastole. There was a late systolic prolapse of the mitral leaflet at rest. The left atrium was enlarged.
The impression of the study was mitral prolapse with regurgitation. Surgery was recommended.
Case Study 9-2: Mitral Valve Replacement Operative Report
A.L. was transferred to the operating room, placed in a supine position, and given general endotracheal
anesthesia. Her pericardium was entered longitudinally through a median sternotomy. The surgeon found
that her heart was enlarged with a dilated right ventricle. The left atrium was dilated. Preopera- tive
transesophageal echocardiogram revealed severe mitral regurgitation with severe posterior and anterior
prolapse. Extracorporeal circulation was established. The aorta was cross-clamped, and cardio- plegic
solution (to stop the heartbeat) was given into the aortic root intermittently for myocardial protection.
The left atrium was entered via the interatrial groove on the right, exposing the mitral valve. The middle
scallop of the posterior leaflet was resected. The remaining leaflets were removed to the areas of the
commissures and preserved for the sliding plasty. The elongated chordae were shortened. The surgeon slid
the posterior leaflet across the midline and sutured it in place. A no. 30 annuloplasty ring was sutured in
place with interrupted no. 2-0 Dacron suture. The valve was tested by inflating the ven- tricle with NSS and
proved to be competent. The left atrium was closed with continuous no. 4-0 Pro- lene suture. Air was
removed from the heart. The cross-clamp was removed. Cardiac action resumed with normal sinus rhythm.
After a period of cardiac recovery and attainment of normothermia, cardio- pulmonary bypass was
discontinued.
Protamine was given to counteract the heparin. Pacer wires were placed in the right atrium and ven- tricle.
Silicone catheters were placed in the pleural and substernal spaces. The sternum and soft tissue wound was
closed. A.L. recovered from her surgery and was discharged 6 days later.CHAPTER 9 • CIRCULATION: THE
CARDIOVASCULAR AND LYMPHATIC SYSTEMS
207
Case Studies, continued
CASE STUDY QUESTIONS
Write the word or phrase from the case study that has the same meaning as each of the following words or
phrases:
1. The state of profuse perspiration
2. Under the tongue
3. Test of cardiac function during physical exertion
4. Disease that includes both heart and blood vessel pathology
5. Excision of the inner lining along with atherosclerotic plaque from an artery (plural)
6. An abnormal heart sound
7. Bluish discoloration of the skin; sign of anoxia
8. The noun form of stenotic
9. Between the atria
10. Below the sternum
Multiple choice: Select the best answer and write the letter of your choice to the left of each number.
_____ 11. The word transluminal means:
a. acrossawall b. between branches c. throughanouterlayer
d. through a central opening e. acrossavalve
_____ 12.The term that means backflow, as of blood, is:
a. infarction b. regurgitation c. amplitude
d. prolapse e. tourniquet
_____ 13. The term for a narrowing of the bicuspid valve is:
a. atrialprolapse b. pulmonic stenosis c. mitralstenosis
d. mitral prolapse e. atrialstenosis
_____ 14. Blowout of a dilated segment of the main artery is:
a.
leftanteriordiastole b. peritoneal infarction
c. coarctation of the aorta d. cardiac tamponade e. ruptured aortic aneurysmStudies,
continue
_____ 15. Sternotomy is:
a. incisionintothesternum b. removal of the sternum
c. narrowingofthesternum d. plastic repair of the sternum e. surgicalfixationofthesternum
_____ 16. Extracorporeal circulation occurs:
a. withinthebrain b. within the pericardium c. withinthebody
d. in the legs e. outsidethebody
_____ 17. Protamine was given to counteract the action of the heparin. This drug action is described as:
a. antagonistic b. synergy
c. potentiating d. similation e. addiction
Abbreviations. Define the following abbreviations:
18. CCU __________________________________ 19. AMI __________________________________
20. CAD __________________________________ 21. LAD __________________________________
22. CHF __________________________________ 23. TEE __________________________________
24. MVR __________________________________