Download CASE STUDY FOR CHAPTER 13

CASE STUDY FOR CHAPTER 13
DISCHARGE SUMMARY
Patient: Martha Wembly
4/4/14
MR#: 445577
Date:
DISCHARGE DIAGNOSES
1. Ventricular tachycardia.
2. Atherosclerotic heart disease.
3. Prolonged sinus pauses.
4. Diabetes mellitus, type 2.
5. Hypertension.
6. Hypothyroidism.
7. Hyperlipidemia.
History: This is a 71-year-old female who was brought into the hospital after
ventricular tachycardia complicated a treadmill stress test in the office on the day of
admission. The patient denies any history of chest pain or chest tightness, though the
patient has had previous shortness of breath on exertion. There was also some
minimal hypoglycemia with blood sugar near 50 and the symptoms transiently
improving after some 50% dextrose was administered. Due to the ventricular
tachycardia and concern of silent MI [myocardial infarction], the patient was
admitted to the hospital for further evaluation and follow-up. The patient’s history
includes high blood pressure, hypothyroidism, hypercholesterolemia [the presence
of an abnormally large amount of cholesterol in the blood], coronary artery disease
status post micro-infarction, and recent PTCA [percutaneous transluminal coronary
angioplasty].
The patient also noted recent onset of fatigue, weight gain, and dry skin. Patient has
a previous history of hypothyroidism; TSH [thyroid stimulating hormone] levels
were drawn and found to be high, indicating that her thyroid hormone levels were
low overall.
Physical Examination: Physical examination revealed a healthy-appearing lady
who appeared her stated age. Vital signs were normal with blood pressure 130/70.
There was a Grade III/VI holosystolic murmur radiating to the left axilla; otherwise,
head, neck, chest, heart, and abdomen exam was unremarkable. Extremities showed
no edema. The neurologic exam was normal.
Hospital Course: Troponins [enzymes found in the heart muscle tissue that indicate
whether myocardial infarction has taken place] were drawn, and the patient was
monitored on the telemetry service. There was no evidence of myocardial infarction.
Doppler echocardiogram was performed, indicating mild dilation of the patient’s
ventricles and atria, as well as an ejection fraction of 50%. A chemical stress test
was performed, during which the patient was noted to complain of dizziness and
long sinus pauses. This became her current problem, and it was clear the patient had
developed second-degree AV block. Accordingly, a Medtronic Elite 7074 SN
YE2118171 pacemaker was implanted.
The patient was asymptomatic after the placement of this and, after 24 hours of
monitoring, was discharged. Her only medication was Synthroid 100 mcg daily,
which was increased from 75 mcg. She will be seen in the office in 1 week and
followed by Dr. DeMare for the pacer site.
G. Morton, M.D.
Discussion Questions
1. What is hypothyroidism? How would this condition affect the patient’s general
health?
2. If the patient were suffering from hyperthyroidism, how would the effect on the
patient’s general health differ?
3. What is a thyroid storm, and why would the admitting doctor want to consider
this as a possible diagnosis?
4. Martha Wembly has a history of diabetes mellitus, type 2. How is this different
from diabetes mellitus, type 1?