Cardiovascular System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M32_F1.jpg"}},{"insert":"\n\n"},{"insert":"As you slip on your white coat with ease at the start of a fresh day, you marvel at the contrast between your completely natural manner at the clinic and the seemingly unassailable awkwardness that takes over when it comes to social interaction.\n"}]}


{"ops":[{"insert":"Cringing at the memory of last night\u0027s date, you\u0027re relieved for the distraction as the door swings open, delivering the first patient of the day into your office.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M32_F3.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Duncan is 56 years old, with a history of hypertension and dyslipidemia for 12 and 7 years respectively, which were poorly controlled due to lack of compliance.\r\n\r\nHe also had an inferior ST-elevation myocardial infarction (STEMI) a year ago, which was treated with percutaneous coronary intervention and the placement of a metallic stent.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M32_F4.jpg"}},{"insert":"\n\n"},{"insert":"He is currently on nitroglycerin, atenolol, aspirin, valsartan, and lovastatin, but stopped attending his clinics around eight months ago, as he \u0027thought (he) was OK now\u0027.\n"}]}


{"ops":[{"insert":"Over the last six months, Mr. Duncan noticed that his legs have slowly swollen up.\r\n \r\nHe has also been getting tired very easily for the last three months and, because of this, has been unable to do his usual gardening at home.\n"}]}


{"ops":[{"insert":"For about a month now, he has been waking at night with bouts of coughing and shortness of breath. He sometimes sleeps sitting up for relief.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M32_F7.jpg"}},{"insert":"\n\n"},{"insert":"Requesting to examine him, you note that Mr. Duncan is visibly dyspneic but with stable vitals:\r\n\r\nBP: 140\/90mmHg\r\nPulse: 100bpm, regular\r\nTemp: 37.0\u02daC\r\nRespiratory rate: 24 cycles per minute\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M32_F8.jpg"}},{"insert":"\n\n"},{"insert":"A cardiac inspection is significant for a raised JVP that disappears into the mastoid process.\r\n \r\nThe point of maximal impulse is displaced to the sixth left intercostal space.\n"}]}


{"ops":[{"insert":"Auscultation reveals a fourth heart sound with a 3\/6 pansystolic murmur radiating to the axilla.\r\n \r\nBibasal crepitations can be heard up to the mid lung zones.\n\nYou worry that Mr. Duncan may have developed congestive cardiac failure.\n"}]}