Unit II Case Study Patient Presentation
A 20-year-old female presents to a prima
Unit II Case Study Patient Presentation
A 20-year-old female presents to a primary care office near her college. She requests an evaluation of a brief loss of consciousness (less than 1 minute in duration) during a tennis match for her college team yesterday. Her athletic trainer expressed concerns about a “syncopal episode.” The patient recalls that her hometown medical provider had detected a murmur during a past sports physical, had ordered an echocardiogram, and prescribed Verapamil. She states that she was advised not to continue playing sports until she was evaluated by a cardiologist. Still, she didn’t want to put her athletic scholarship at risk, so she never followed up with cardiology.
She reports that, in recent months, she has had several episodes of feeling lightheaded while playing tennis. When the patient was 15 years old, her father died from sudden cardiac death (age 47) while on a run with their family dog. Then, a month ago, her 18-year-old cousin died after a basketball game.
The patient endorses generalized fatigue. She currently denies lightheadedness, shortness of breath, chest pain, headache, and weight loss.
Create a problem list based on this patient presentation only. A bullet-point list acceptable?
Identify five differential diagnoses for this patient supported by a problem-based rationale. Use the problems identified in question #1 to support your differentials?
Physical Exam
Vital signs: Temperature 97.8 degrees Fahrenheit and oxygen saturation 99% on room air. While supine, the heart rate is 88 bpm, blood pressure 128/64 in the right arm and 118/68 in the left arm. When standing, her pulse is 82, and her blood pressure is 118/64 on the right and 112/66 on the left.
Lungs: Lungs are clear to auscultation bilaterally.
Heart: Carotid upstrokes are brisk, but seem to have a double pulsation. The point of maximal impulse (PMI) is prominent and displaced slightly inferolaterally.
Abdomen: Bowel sounds present. Soft, nontender, no masses.
Extremities: No edema. Strong radial and pedal pulses, equal bilaterally.
3. After reviewing the physical exam findings, which of your differential diagnoses (identified in question #2) is most likely? If you do not believe any of your original differentials are likely, what new differential are you considering?
Electrocardiogram shows sinus rhythm at 90 bpm with inferior Q-waves, anterolateral T-wave inversion, and ST depression in aVL.
5. Based on this testing, can this patient be diagnosed with hypertrophic cardiomyopathy? If not, what testing is necessary to confirm a diagnosis of hypertrophic cardiomyopathy? What are the expected findings of definitive testing if the patient has hypertrophic cardiomyopathy? Include an APA 7th edition reference (citation, year, page number) to support your answer.
Describe the role of genetics in this disorder. In your response, specifically address how this patient developed hypertrophic cardiomyopathy. Describe the pathophysiological rationale down to the cellular level. Include an APA 7th edition reference (citation, year, page number) to support your answer?
6. Why was this patient advised not to play sports? Does she have a real risk of sudden death? Include an APA 7th edition reference (citation, year, page number) to support your answer?
7. Submit one article focused on the pathophysiology of the final diagnosis in this case study?
8. Summarize the article uploaded in question #7. Your summary should not exceed 10 sentences. Answer the following questions in your summary:
Is the article a primary or secondary source?
Does the article describe the pathophysiology of a disease process down to the cellular level?
How did the article assist you in completing the case study?