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1、CaseNum214PtNameAmyFarrahAddress10SWMerlinCourtAge68Height5'11"Weight125lbSexFRaceWhiteAllergiesCodeineSectionNameOrganTransplantationCaseNameCardiacTransplantationChiefComplaintTransferfromSt.AndrewMedical CenterincardiogenicshockHxPresIllnessAFisa68-year-oldwomanwithcoronaryarterydiseaseadmitte
2、d10daysagowithchestpainforabout3hours,diaphoresis,andshortnessofbreath,whichwasprecededbyabout3daysofshortnessofbreath,dyspneaonexertion,wheezing,andorthopnea.Onpresentation,shewastachycardicandnormotensive,andEKGrevealedlossofRwavesacrosstheanteriorprecordiumwithnoacuteSTorTwavechanges.Chestx-ra
3、yrevealedpulmonaryedema.InitialCKwas505.Shewasfoundtohavenormalrenalfunctionandnormalhematocrit.Anechocardiogramrevealedanteroseptalakinesis,alaminarclot,posteriorandinferiorrightventricularhypokinesis,severetricuspidregurg,andmildmitralregurg.Shehadacardiacindexof1.4.Thepatientison100%nonrebreat
4、hermaskwhileplansareunderwayforhearttransplantation.PastMedicalHxCHF;goingforHHTxtodayParkinson'sdiseasewhichisfelttobemild,managedonlywithArtanewhichcontrolsamildtremorHiatalherniaEndometrialcancerGERDSeverekyphosisandscoliosisSocialHxShelivesindependently.Sheismarriedwithverysupportivefamily,ch
5、urch,andhusband.Sheisactiveanddrives.Sheisaretiredsecretary.FamilyHxIncludesahistoryofcoronaryarterydiseaseReviewOfSystemsVS:Temperature37.5°C,bloodpressureinitially155/85mmHg,decreasingto110-120/40-60,heartrate85-90,respirations10/10onaventilatorShecamewithanintraaorticballoonpump1:1.InitialSwan
6、numbersrevealedacardiacindexof1.49,acardiacoutputof2.55,aCVPof10,apulmonaryarterywedgepressureof22,systemicvenousresistanceof1474,andapulmonaryvascularresistanceof188atthetimeoftransfertotransplantation.13PhysicalExamGEN:Ingeneral,sheissedatedandquicklybecamemoreawakeandalertaspropofolwasdecrease
7、d.Shewasintubatedandventilated.HEENT:PERRLACARDIOVASCULAR:S1,S2.Balloonpumpmadeheartsoundsdifficulttoassessfurther.LUNGS:Bilateralcracklestobilateralbasesbutbilateralexchangethroughout.ABDOMEN:Bowelsoundswereactive.Abd