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Файл:Frailty syndrome clinic, diagnosis, treatment. Study aid
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121
LDL — 3.69 mmol/l, HDL — 0.97 mmol/l, TG — 2.26 mmol/l, fasting
glucose — 4.5 mmol/l. ECHO-KG: left ventricular hypertrophy,
enlargement of the left atrial cavity. Local hypokinesia of the lateral wall of
the left ventricle. Mitral regurgitation 2 tbsp., Tricuspid regurgitation 1 tbsp.
Violation of the diastolic function of the left ventricle (VE/VA < 1.0). PV —
48 %. The period of inpatient treatment was uneventful, after discharge the
patient was sent to a specialized cardiorehabilitation hospital, where he
stayed until October 5, 2016. The results of the test with a 6-minute walk:
412 meters were covered in 6 minutes. On October 6, 2016, he came to the
clinic at the place of residence. Pain in the heart does not bother, when
walking there is shortness of breath. Constantly taking aspirin 100 mg/day,
clopidogrel 75 mg/day, atorvastatin 40 mg/day, bisoprolol 2.5 mg/day,
lisinopril 5 mg 2 times per day. On examination: the condition is
satisfactory. BMI — 37 kg/m2. The skin is clean, normal color. Pastosity of
the feet. In the lungs, vesicular breathing, no wheezing. NPV 16 per min.
Heart sounds are weakened, the rhythm is correct. Heart rate — 70 beats. in
min., BP — 150/100 mm Hg. The abdomen is soft, painless on palpation in
all departments. The liver and spleen are not enlarged. There are no dysuric
disorders. The symptom of tapping in the lumbar region is negative on both
sides.
Questions:
1. Formulate a diagnosis and justify it.
2. Evaluate the physical examination data and the result biochemical
analysis, correct the medication therapy.
3. Develop a rehabilitation program at the outpatient clinic stage.
Case 4:
A 70-year-old man called an ambulance. Complains of intense
pressing retrosternal pain radiating to the left arm, left shoulder blade, which
appeared about 2 hours ago after intense physical exertion, a feeling of lack
of air. I took 2 tablets of nitroglycerin on my own — without effect.
Previously, pain of this nature had never bothered. History of arterial
hypertension over the past 15 years with a maximum blood pressure of
122
200/100 mm Hg. I did not take regular medications. Smoked 1 pack of
cigarettes a day for 30 years. Allergic reactions are denied. An objective
examination: a state of moderate severity, the skin is moist, pale. There are
no edema. In the lungs, the percussion sound is pulmonary, vesicular
breathing, wheezing on exhalation. Heart sounds are weakened, the rhythm
is correct, blood pressure is 160/100 mm Hg. Art., heart rate — 88 per
minute. The abdomen is soft and painless. Liver on the edge of the costal
arch. ECG: sinus rhythm, ST segment elevation > 0.2 mV in leads II,
III, aVF. Transport accessibility to the emergency cardiology hospital,
which has the ability to perform primary PCI — 30 min.
Questions:
1. Assume the most likely diagnosis, justify it.
2. What should be the tactics of managing a patient at the prehospital
stage?
3. What amount of medical care should be provided to the patient at
the prehospital stage?
4. Is there enough data to make a diagnosis of myocardial infarction?
123
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