Question

According to this case study and information what disease

do I have?

I have a 65 year old man that has brought into the ED because his wife called 911; stating her husband has fainted, and is having a hard time breathing. According to the wife 6 years ago her husband had surgery on a peptic ulcer, and has been in the ED three times prior for episodes of hemispheres, with regression, and cognitive deficit.

Upon inspection patient was placed on telemontary, complaining or heart palpation, chest pain, fatigue, and shortness of breath. Patient ways 85 kg, 70 inches tall, BP 133/50, Pulse 105, temperature is 37.5 C, 89% O2, 28 RR, +2 edema on lower extremities.

Lab values included: Hemo 11.1, Platelets 94000, Cr 6.41, Urea 218, CRP 312, PT 2.6, pH 7.11, CO2 47.6, O2 83.2, HCO3 14.6.

Nursing Diagnosis: Fatigue related to sustained sense of exhaustion as evidence by patient weakness. Electrocardiograph evaluation showed dilation and mild dysfunction of the left ventricle. ECG showed A-fib, left branch block, left ventricular overload.

Choices:

Mitral Stenosis

infective endocarditis

myocarditis

pericarditis

rheumatic heart disease

aortic valve regurgitation

mitral valve regurgitation

dilated cardiomyopathy

hypertrophic cardiomyopathy

restrictive cardiomyopathy

Aortic valve stenosis

Answer 1

• Based on subjective and objective findings this patient might have dilated cardiomyopathy that might decrease the cardiac output resulting in decreased blood perfusion to kidneys .
• As, a result the renal parameters (blood urea and serum creatinine were raised).
• The chief cause of left branch block (LBB) is dilated cardiomyopathy, whereas cause of dilated cardiomyopathy is varied including ischemic, inflammatory, infective , valvular causes.
• Treatment includes selective beta blockers, ACE inhibitors/ARB (angiotensin ii receptor blockers and aldosterone antagonists can prevent the progression to heart failure.