Question

DISCHARGE SUMMARY

Patient: Martha Wembly             MR#: 445577                                                             Date: 4/4/14

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.

1. 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?
5. Would you make any other recommendations or referrals for this patient and her long-term disease management?

Answer 1

HYPOTHYROIDISM

Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate,body temperature and all aspects of metabolism.hypothyroidism is most prevalent in older women.this condition affect the general health of patient .It includes

• fatigue
• cold sensitivity
• constipation
• dry skin
• un explained weight gain etc...

HYPERTHYROIDISM

Hyperthyroidism is the condition in which over production of a hormone by the butterfly shaped gland in the neck.It is the production of too much of thyroxine hormone.It can increase metabolism.the symptoms of hyperthyroidism is differ from hypothyroidism .he symptoms include

1. unexpected weight loss
2. rapid or irregular heartbeat
3. sweating and irritability
4. although the elderly often experience no symptoms
5. insomnia
6. hair loss
7. muscle weakness
8. puffy eyes

THYROID STORM :

Thyroid storm is a life threatening health condition that is associated with untreated or undertreated hyperthyroidism.During thyroid storm,an individual's heart rate,blood pressure,and body temperature can soar to dangerously high levels.the doctor reach at the conclusion by identifying the below symptoms such as

• sweating
• feeling hot
• palpitations
• weight loss
• symptoms of thyroid storm are more severe resulting in complications such as fever ,dehydration,rapid heart rate.

DIABETES MELLITUS

people with type2 diabetes don't respond to insulin as well as they should and later in the disease often don't make enough insulin.people with type1 diabetes don't produce insulin.both type of diabetes ,if not treated shows symptoms including,

• frequent urination
• feeling very thirsty and drinking a lot
• feeling very hungry
• feeling very fatigued
• blurry vision
• cuts or sores that don't heal properly

TYPE !	TYPE 2
auto immune disease	insulin resistance
no longer produces insulin	doesn't produce enough insulin or the body is resistant to it
beta cells have been destroyed	beta cells deteriorate overtime
dependent on insulin	insulin injections may be required at some point
lifestyle changes cannot reverse the condition	life style changes and oral medications ca help produce insulin more effectively

Here now the patient is asymptomatic,after the placement of pacemaker in the hospital course.physical examination findings also quiet normal.excerted work should be avoided by the patient.regular pacemaker checkup should be taken.