Physical Examination and Laboratory Tests
Vital Signs
BP 125/80 (left arm, sitting); P 125 and regular; RR 28 and labored; T 98.5°F oral;
Weight 215 lb; Height 58; patient is appropriately anxious
Head, Eyes, Ears, Nose, and Throat
Funduscopic examination normal
Pharynx and nares clear
Tympanic membranes intact
Skin
Pale with cool extremities
Slightly diaphoretic
Neck
Neck supple with no bruits over carotid arteries
No thyromegaly or adenopathy
Positive JVD
Positive HJR
Patient Case Question . What can you say about this patient’s blood pressure?
Patient Case Question . Why might this patient be tachycardic?
Patient Case Question . Why might this patient be tachypneic?
Patient Case Question . Is this patient technically underweight, overweight, obese, or is her weight healthy?
Patient Case Question . Explain the pathophysiology of the abnormal skin manifestations.
Patient Case Question . Do abnormal findings in the neck (JVD and HJR) suggest left heart failure, right heart failure, or total CHF?
Lungs
Bibasilar rales with auscultation
Percussion was resonant throughout
Heart
PMI displaced laterally
Normal S1 and S2 with distinct S3 at apex
No friction rubs or murmurs
Abdomen
Soft to palpation with no bruits or masses
Significant hepatomegaly and tenderness observed with deep palpation
Br
12 PART 1 ■ CARDIOVASCULAR DISORDERS
Extremities
2 pitting edema in feet and ankles extending bilaterally to mid-calf region
Cool, sweaty skin
Radial, dorsal pedis and posterior tibial pulses present and moderate in intensity
Neurological
Alert and oriented 3 (to place, person, and time)
Cranial and sensory nerves intact
DTRs 2 and symmetric
Strength is 3/5 throughout
Chest X-Ray
Prominent cardiomegaly
Perihilar shadows consistent with pulmonary edema
ECG
Sinus tachycardia with waveform abnormalities consistent with LVH
Pronounced Q waves consistent with previous myocardial infarction
ECHO
Cardiomegaly with poor left ventricular wall movement
Radionuclide Imaging
EF 39%
Patient Case Question . Which abnormal cardiac exam and chest x-ray findings closely complement one another?
Patient Case Question . Which abnormal cardiac exam and ECG findings closely complement one another?
Laboratory Blood Test Results
See Patient Case Table 3.1
Patient Case Table 3.1 Laboratory Blood Test Results
Na 153 meq/L PaCO2 53 mm Hg
K 3.2 meq/L PaO2 65 mm Hg (room air)
BUN 50 mg/dL WBC 5,100/mm3
Cr 2.3 mg/dL Hct 41%
Glu, fasting 131 mg/dL Hb 13.7 g/dL
Ca2 9.3 mg/dL Plt 220,000/mm3
Mg2 1.9 mg/dL Alb 3.5 g/dL
Alk phos 81 IU/L TSH 1.9 µU/mL
AST 45 IU/L T4 9.1 µg/dL
pH 7.35
CASE STUDY 3 ■ CONGESTIVE HEART FAILURE 13
Patient Case Question . What might the abnormal serum Na and K levels suggest?
Patient Case Question . Explain the abnormal BUN and serum Cr concentrations.
Patient Case Question . What might be causing the elevated serum glucose concentration?
Patient Case Question . Explain the abnormal serum AST level.
Patient Case Question Explain the abnormal arterial blood gas findings.
Patient Case Question . Which of the hematologic findings, if any, are abnormal?
Patient Case Question . What do the TSH and T4 data suggest?
Patient Case Question Identify four drugs that might be immediately helpful to this patient.
Patient Case Question . Ejection fraction is an important cardiac function parameter that is used to determine the contractile status of the heart and is measured with specialized testing procedures. If a pa
