Pathology CPS

Question 1

A 52 year old male presents with 6 month hx of increasing shortness of breath on exertion. He is a former smoker and has had two miès (six and four years previous). He was treated medically. Now he denies subsequent angina. Lately he has experienced severe exercise limitation, orthopnea,paroxysmal dyspnea and occasional hemoptysis
1) What causes of shortness of breath should you consider given the patients hx

Answer 1

Cardiac:
-congestive heart failure
Pulmonary:
-COPD
-lung cancer

Question 2

On physical exam, his breathing and HR are rapid, he has evidence of pleural effusions and ascites, his liver is enlarged and there is marked pitting edema of the lower extremities. There is a grade III VI pansystolic murmur, best audible in the area of the cardiac apex
What is your clinical diagnosis

Answer 2

Left and right sided cardiac failure (congestive heart failure)

Question 3

On physical exam, his breathing and HR are rapid, he has evidence of pleural effusions and ascites, his liver is enlarged and there is marked pitting edema of the lower extremities. There is a grade III VI pansystolic murmur, best audible in the area of the
What functional abnormality does this cardiac murmur indicate

Answer 3

Apical region = where mitral valve abnormalities are heart

-pansystolic indicates regurgitant flow across the valve in advanced mitral insufficiency

Question 4

What are some common causes of mitral insufficiency

Answer 4

1) Mitral valve prolapse (myxomatous degeneration)
2) Infective endocarditis
3) Rheumatic valve disease
4) Hypertrophic cardiomyopathy
5) Ischemic heart disease with papillary muscle dysfunction
6) Abnormalities of the mitral valve ring (calcification)
7) Marked left ventricular enlargement from any cause

Question 5

What is the most likely etiology of this patients mitral insufficiency

Answer 5

Combo of

1) stretching of the annulus from LV dilation
2) Papillary muscle dysfunction from ischemia

Question 6

73 year old male diabetic with hx of mi 10 years prev. presents with chest pain on exertion that is becoming difficult to relieve with medication. Clinical work-up shows electrocardiographic and serum changes of acute mi. The ECG shows features of LV hypertrophy
-list some causes of LV hypertrophy

Answer 6

1. Ischemic heart disease
   - compensatory muscle hypertrophy + or - ventricular dilation
2. Valvular heart disease
   - aortic stenosis
   - aortic regurg
   - mitral regurg
3. Systemic hypertension
   - chronic afterload increase