Paul F. Moodispaw, M.D., F.A.C.C. Clinical Assistant Professor of - PowerPoint PPT Presentation

Paul F. Moodispaw, M.D., F.A.C.C. Clinical Assistant Professor of Medicine The Ohio State University Wooster Community Hospital Wooster, Ohio No Disclaimers

Case for Review • 2007 • 32 Year Old White Male • Chief Complaints – 1 – 2 Months – Chest Discomfort (“Brinks Truck Sitting on My Chest”) – Shortness of Breath with Exertion – Orthopnea – Cough

Case for Review • Allergies – No Known Drug Allergies • Past Medications – None • Past Medical History – Myocardial Infarction (x 2 approx. 10 years ago) – Asthma – Epilepsy

Case for Review • Family History – Both parents with a history of “MI” – Sister at age 29 with a history of “MI” • Social History – Denied: tobacco use; alcohol use; illicit drugs • Review of Systems – Denied: fevers, chills, night sweats, edema, palpitations, near syncope / syncope

Physical Examination • Vital Signs – HR 110; BP 97/50 mmHg; RR 22; Afebrile • HEENT – PERRL; EOMI; Neck was supple with good ROM; – No lymph node enlargement • Lungs – Diminished bibasilar breath sounds • Cardiovascular – RR, nl s1, s2 (distant heart tones), without obvious m/r/g • Abdomen – + BS, soft, non tender, no organomegaly • Extremities – No obvious lower extremity edema • Neuro – No focal motor or sensory deficits

Outside Medical Records • > 10 years prior to 2007 presentation: • Chief complaint: chest discomfort • Grady Memorial Hospital, Delaware, OH – No medical records available • South Georgia Medical Center, Valdosta, GA – Cardiac enzymes: negative – ECG: NSR; NS ‐ T wave change (no report of a LBBB) – CXR: left pleural effusion – DX: left rib pain – TX: anti inflammatory therapy & referred for outpatient evaluation – Follow up: none secondary to lack of finances, insurance and moving.

Laboratory Studies • WBC: 7.8 • H/H: 13.9 / 39.9 • PLTs: 207 • Na2+: 140 • K+: 3.2 • Cl: 106 • CO2: 26 • Bun: 15 • Cr: 1.4 • Glucose: 122 • CPK / Troponin I profile: negative • TSH: within normal limits