A 72-year-old man with intermittent fever, anemia and a history of coronary and peripheral artery disease (original) (raw)

Case 6/2015 - 40-Year-Old Female with Acute Chest Pain, Dyspnea and Shock

Arquivos Brasileiros de Cardiologia, 2015

The patient is a 40-year-old female referred to the emergency unit due to thoracic pain, dyspnea and shock. She reported a history of arterial hypertension, IgA nephropathy and HELLP syndrome in pregnancy (hypertension, hemolysis, increased liver enzymes and low platelet count). The patient sought the Osasco Regional Hospital complaining of chest and low back pain and lower limb paresthesia (Nov 10, 2013), being then assessed and discharged. As her symptoms persisted, she returned to that hospital on the following day. On admission, the patient showed hypotension (80/50 mmHg), hyperthermia (temperatures ranging from 37.8°C to 38°C), hypoxemia, crepitant rales in both lungs, and heart murmur on auscultation.

A Young Man with Anemia and Recurrent Tachyarrhythmic Episodes

Respiration, 2013

28 mm/h, normal total bilirubin, serum creatinine 0.65 mg/dl, total protein 7.1 g/dl, normal IgA, IgM and IgG concentrations and serum albumin of 3.4 g/dl. Anti-gliadin antibody tests were negative, but the IgA endomysium assay and anti-tissue transglutaminase antibody tests were not performed. Urinalysis was negative. A chest Xray showed neither pleural-parenchymal alterations nor cardiomegaly. An electrocardiogram revealed sinus tachycardia. Search for fecal occult blood (in 3 stool samples) was negative. Abdominal echography revealed no alterations or free abdominal effusion. Colonoscopy was unremarkable. In esophagogastroduodenoscopy, there were no stomach lesions but duodenal bleeding due to hemorrhagic telangiectasia; duodenal biopsy evidenced a nonspecific chronic duodenitis pattern without any other structural alterations. 99m Tc-labeled red blood cell scintigraphy did not show any pathological accumulation suggestive of intestinal hemorrhage. The patient was given intravenous iron and received 4 units of red blood cell concentrates. At discharge, he had a stable Hb value of 8.4 g/dl.

A 79-Year-Old Man With Dyspnea and a Cold Shock

Chest, 2019

A 79-year-old man was brought to the ED with progressive dyspnea, dizziness, tachycardia, and arterial hypotension, which developed over the last 48 h. Personal medical history revealed past smoking. On presentation, his vital signs were a respiratory rate of 36 breaths/min, heart rate of 130 beats/min, arterial pressure of 90/60 mm Hg, oxygen saturation of 98% breathing oxygen at a flow of 4 L/min, and axillary temperature of 36 C. Physical examination showed a severely distressed patient, with dyspnea, effortful tachypnea, cold and pale skin and mucous membranes, and skin mottling over the thighs and knees. He did not manifest chest or abdominal pain. Cardiac auscultation showed rapid and regular heartbeats, with no audible S3, S4, or murmurs. Peripheral pulses were filiform. Lung auscultation was normal. The abdomen was nontender. Surface ECG showed sinus tachycardia, a 1-mm ST elevation in aVR, and a 1-mm ST depression from V2 to V5. Laboratory data showed a blood hemoglobin level of 8.5 g/dL, a WBC count of 17,000 cells/mL

A 53-Year-Old Woman With a Myocardial Infarction, Hypotension, and Abdominal Distension

CHEST Journal, 2009

A 53-year-old woman presented to the emergency department with a history of substernal chest pain and dyspnea for 1 h. Her medical history was Significant for hypertension, severe thoracic kyphoscoliosis, and idiopathic deep venous thromboembolism. She was currently not receiving any medications. Physical Examination The patient was .5 feet .3 inches tall, and weighed 50 kg. She had a shortened trunk, kyphoscoliosis, and a protuberant abdomen. Her initial heart rate was 122 beats/min, BP was 82/40 mm Hg, respiration was 20 breaths/min, and peripheral arterial oxygen saturation was 85% on room air. She had perioral cyanosis and was in respiratory distress. Her lungs were clear to auscultation initially but developed diffuse rales over a period of 10 minutes. Laboratory Findings and Irnaging The results of a CBC, chemistry panel, and coagulation panel were normal. Her troponin concentration was 0.86, and the brain natriuretic peptide concentration was 44. The ECG showed inferior ST