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

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

Apr 15, 2023 40 likes •110 views

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

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SLIDE 1

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

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SLIDE 2

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

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SLIDE 3

Case for Review

  • Allergies

– No Known Drug Allergies

  • Past Medications

– None

  • Past Medical History

– Myocardial Infarction (x 2 approx. 10 years ago) – Asthma – Epilepsy

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SLIDE 4

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

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SLIDE 5

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

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SLIDE 6

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.

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SLIDE 7

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