G.L. is a 56-year-old man who fainted while exercising. He reports having heart palpitations, chest pain,...

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G.L. is a 56-year-old man who fainted while exercising. He reports having heart palpitations, chest pain, shortness of breath, and fatigue, all of which are often precipitated by increased exertion. Symptoms may last an hour or more, compelling him to remain inactive until they stop. Physical Exam: • Average body frame. Height = 6'2"; Weight = 250 pounds • Heart Rate = 80 bpm (normal = 70 bpm). • Heart sounds indicate a mid-systolic ejection murmur, heard best over the "aortic area" or right second intercostal space, with radiation into the right neck. S2 was weak and a prominent fourth heart sound ($4) was heard. • Blood pressure = 127/85; Respiration rate = 18 breaths/min (normal = 12-18 breaths/min) Blood Tests for G.L. Cardiac Troponin I G.L.'s values Normal values Cardiac Troponin I (cTnl) 0.01 ng/mL <0.1 ng/mL Echocardiogram • GLs physician orders an echocardiogram to look for potential causes of his symptoms. Hs physkcian notes a thickened aortic valve and left ventricle hypertrophy. Normal echocardiogram: ght ventricle (RV); interventricular septum pvs), aoric valve (AV): let ventricle (LV): mitral valve (MV): ieft atrum (LA). QL'S echocardiogram: interventricuiar septum (IVS): aortie valve (Aov) let ventricie: (LV): meral valve (MV). left atrum (LAI. Echocardiogram of normal heart Echocardiogram of G.L's heart Exercise stress tost for G.L: Positive: Chest pain reproduced. ST depression noted on EKG. EKG for G.L. taken while exercising indicates left ventricular hypertrophy with inverted T wave. Nomal EKG GLSEKG 1 mv 10s Questions: 1. What is indicated by the heart murmur, diminished S2, and presence of S4 heart sounds? 2 Examine the patient's cardiac troponin test results. What does this resut tell you about his condition? 3. What is the most likely cause of GL's chest pain (angina or an acute myocardial infarction)? What evidence led you to this conclusion? 4. What is the final diagnosis of G.L's hoart condition (name the diseasej? What evidence led you to that conclusion? & Describe how G.L's condition caused syncope following exercise. 6 What is left ventricular hypertrophy? Why would G.L.'s condition lead to left ventricular hypertrophy? 7. What does the invarted Twave indicate? Why does it appoar only when the patient exercises? a What is the typical troatment for G.L's condition? G.L. is a 56-year-old man who fainted while exercising. He reports having heart palpitations, chest pain, shortness of breath, and fatigue, all of which are often precipitated by increased exertion. Symptoms may last an hour or more, compelling him to remain inactive until they stop. Physical Exam: • Average body frame. Height = 6'2"; Weight = 250 pounds • Heart Rate = 80 bpm (normal = 70 bpm). • Heart sounds indicate a mid-systolic ejection murmur, heard best over the "aortic area" or right second intercostal space, with radiation into the right neck. S2 was weak and a prominent fourth heart sound ($4) was heard. • Blood pressure = 127/85; Respiration rate = 18 breaths/min (normal = 12-18 breaths/min) Blood Tests for G.L. Cardiac Troponin I G.L.'s values Normal values Cardiac Troponin I (cTnl) 0.01 ng/mL <0.1 ng/mL Echocardiogram • GLs physician orders an echocardiogram to look for potential causes of his symptoms. Hs physkcian notes a thickened aortic valve and left ventricle hypertrophy. Normal echocardiogram: ght ventricle (RV); interventricular septum pvs), aoric valve (AV): let ventricle (LV): mitral valve (MV): ieft atrum (LA). QL'S echocardiogram: interventricuiar septum (IVS): aortie valve (Aov) let ventricie: (LV): meral valve (MV). left atrum (LAI. Echocardiogram of normal heart Echocardiogram of G.L's heart Exercise stress tost for G.L: Positive: Chest pain reproduced. ST depression noted on EKG. EKG for G.L. taken while exercising indicates left ventricular hypertrophy with inverted T wave. Nomal EKG GLSEKG 1 mv 10s Questions: 1. What is indicated by the heart murmur, diminished S2, and presence of S4 heart sounds? 2 Examine the patient's cardiac troponin test results. What does this resut tell you about his condition? 3. What is the most likely cause of GL's chest pain (angina or an acute myocardial infarction)? What evidence led you to this conclusion? 4. What is the final diagnosis of G.L's hoart condition (name the diseasej? What evidence led you to that conclusion? & Describe how G.L's condition caused syncope following exercise. 6 What is left ventricular hypertrophy? Why would G.L.'s condition lead to left ventricular hypertrophy? 7. What does the invarted Twave indicate? Why does it appoar only when the patient exercises? a What is the typical troatment for G.L's condition?

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1 Murmur is an abnormal heart sound which heard over the Herat areas which is due to heart valve problems S2 heart sound usually diminished or absent because the aortic valve is calcified or immobile ... View the full answer