Reference no: EM133509865
Case: A few hours after you last talked to Mr. XYZ about his chest pain, you receive additional lab results. For your convenience, the case will be reviewed again. Mr. XYZ's a 57 year old Caucasian male who you recently saw in the clinic for the first time for evaluation of generalized abdominal pain and fullness, urinary frequency. Physical exam, vital signs: temperature's 98.6. Heart rate is 100. Respiratory rate is 26. Blood pressure is 158/96 and O2 sat is 92% on two liters of nasal cannula. He's alert and oriented times three, obese and mildly dyspneic. He's normocephalic and atraumatic. Head: pupils are equal, round and reactive to light. There's no nystagmus or scleral icterus. The neck is supple. There is three centimeters of JVD present bilaterally. There's no tracheal deviation, thyromegaly or thyroid nodules. Has a normal heart rate. S1 is normal. S2 is present with a S3 being present as well. There's +2 edema in the lower extremities noted bilaterally. The brachial, radial, dorsalis pedis and posterior tibial pulses are 2+/4+ bilaterally. Again, he's dyspneic, but is not using accessory muscles. Respirations are regular and even. Lungs are with rales in the anterior and posterior lung fields bilaterally. He is obese. His abdomen is soft. Bowel sounds are active. He does have generalized tenderness in the abdomen. There are no masses noted. There's no CVA tenderness. We're unable to palpate the liver due to the body habitus. There's no rigidity, rebound or guarding. Lymph nodes. No cervical lymphadenopathy. Cranial nerves II to-XII are intact. skin is warm, dry and intact. He has a mood and affect that is normal, calm, and cooperative behavior, and the judgement is intact. He's not taking any medications. And after seeing Mr. XYZ, you ordered several labs and tests and some additional lab results are now available.
So the available lab results, we have:
AST of 60
ALT of 58
Total Cholesterol of 250
LDL of 180
HDL of 15
Triglycerides of 275
Troponin of 0.6
Other diagnostic test results available:
Chest x-ray: shows cardiomegaly with Kerley lines
Echocardiogram: shows left ventricular ejection fraction of 35%, impaired left ventricular relaxation, left and right atrial hypertrophy, right ventricular hypertrophy, and pulmonary hypertension
After reviewing the results, you go back to see Mr. XYZ to discuss diagnoses and answer the following questions:
Question 1. Based on the current information available, what diagnoses do you believe Mr. XYZ has?
Question 2. What labs and/or diagnostic do you believe are needed at this time?
Question 3. Describe the pathogenesis, which explains Mr. XYZ's condition, his physical symptoms and diagnostic test results.
Question 4. What education is important for Mr. XYZ to receive?