Question

Topic: Acute dyspnea

A 45 year old woman presents to the ER with severe, acute shortness of breath that started after a ten-hour bus trip. Minutes after the patient exited the bus, she felt severe chest pain in the left lower side of the thorax, accompanied by dyspnea.

Patient’s past history: P4, A1, C3, D0. LMD previous week. Oral contraconceptives. Smokes ten cigarettes per day, denies alcoholism or drug use.

Physical examination: T:36.6°C, BP: 145/95mmHg, HR 120bpm, RR 40bpm. SatO2 76%. Restless, anxious patient. Thoracoabdominal breathing, very low respiratory sounds. Cardiac sounds with gallop, abdomen within normal limits. Achrocyanosis, lower extremities with visible, varicose-vein pattern.

EKG: sinus rhythm, tachycardia , right ventricle overload, 2nd degree bundle block, no indication of ischemia. D-dimer: 0.7µg/ml; Fibrinogen:350mg/d

What condition is this patient showing?

Answer 1

Based on symptoms, the patient may be suffering from left sided heart failure.

For left side heart failure, due to inability to pump blood from left ventricle , blood flows back to lungs and leads to shortness of breath.

Risk factors are

• Coronary artery disease
• High blood pressure
• Heart attack
• Diabetes mellitus
• Abnormal heart sounds
• Congenital heart disease
• Valvular disease
• Certain medications

Here, patient has high blood pressure , and diagnosed with 2 nd degree heart block..