113Tidbits

History: A 10 year old Chinese girl presents with fever and joint swelling of 8 days duration.

Physical Examination: A thin underdeveloped female presents with a blood pressure of 122/68, heart rate is 86 bpm. She has a grade 3 harsh holosystolic murmur heard best at the apex of her heart. There is also a 2/6 early diastolic decrescendo murmur detected at the left sternal border. An S3 is present. The EKG demonstrates a 1st degree AV block. chest x-ray is normal.

The above symptoms would lead me to believe that the patient is suffering from acute rheumatic fever. This diagnosis of course is only based on the length of fever and whether the child had strep throat that was left untreated. Check out the video below for a more detailed explanation of rheumatic fever and how if left unchecked can lead to more complicated heart conditions.

Case one for review was pretty difficult since it incurred the need to assign a variety of different symptoms. Check it out below. The case/history is as follows:

History:

A 48 year old man presents to the emergency room with a complaint of several hours of chest discomfort. He has no previous history of cardiac disease. His risk factors are amplified by the fact that he has smoked over 25 years and a father with a substantial coronary artery disease.

The physical examination of the patient is 100/60 blood pressure, pulse is 77bpm. He is pale and diaphoretic (sweaty). The jugular veins are distended. Chest x-ray shows nothing remarkable and clear. There is an S4 sound at the xiphoid area of the chest with no murmurs heard. The EKG shows ST elevation in leads II, III, and AVF.

After going over all of the parameters, I came up with the answer that the patient suffered from coronary artery disease.