The Cardiology Clinic

17 years old malay lady was referred to the cardio clinic for valve replacement therapy. She is a known case of .

In the social history, she just finished her SPM and is just staying at home with her parents. Her father is a fisherman and mother is a housewife
Admitted in July 2011 for:
1) B-Thallasemia Intermediate
　
　
2) Congenital Heart Disease in failure complicated by ventilator assisted pneumonia, sacral sore and pneumothorax
ECHO (July 2011): Thickened valve leaflets, mod AR and severe MR with valve prolapse
Tracheal Aspirate (7/7/2011): Burkhodelia cepasia
rpt culture @ 11/7/2011: burkhedellia cepasia
rpted culture on 14/7/2011: <RSA
latest TA @ 18/7/2011: no pathogen isolated
　
　
3) Right foot drop ? secondary to malpositioning whilst intubated
doing physiotherapy under rehab HSB
　
　
　
　
pt was admitted to Hospital Tanjung Karang initially for anemia
she was transfused at least 4p PC - she was told that she had thallasemia and the other family members need to be screened for it
　
　
she also complained of cough, fever, SOB and generalised edema
later on, she was transferred to HSB in view of worseining anarsace (generalised edema) where she was intubated for more than 1mth --> initially intubated then put on tracheostomy
She was treated with frusemide as inpatient
　
　
She was discharged well on T captopril 25mg BD, T metoprolol 25mg BD and hemetinics.
Currently she denied any SOB, palpitation or leg swelling
She claim to have on and off chest pain - can be at rest or on exertion
　
　
BO/ PU as normal
no diarrhea/ vomitting
no fever/ fits/ faints
　
　
　
　
　
Social & Occupational History
mother and father - not govn servants, father is a fisherman
4/8 siblings
born SVD at term - was well till age 11 years old
She presented at 11 years old with rapid breathing --> was seen in Hospital Tanjung Karang then transferred to Hosp Klang --> sb IJN for heart problem - was told that it was too early for a valve replacement therapy
　
　
3rd child - bowel operation on D2 of birth ? intussusception, currently well
no FHx of congenital heart disease
Physical ExaminationGeneral Examination
　
alert
mild pallor
small build
finger clubbing+
walking with a limp - pt not wearing her splint for the right foot drop
　
　
　
　
BP 123/ 78
HR 88bpm reg
Collapsing pulse +
no radio - radial or radio-femoral delay
JVP not raised
no stigmata of IE
　
　
Lungs: clear, no crepitations
CVS: Thrills palpable over the precordium, Apex displaced at 6th ICSMCL
HS I + II + PSM heard loudest at the LSE, radiating to the axilla
Right foot drop with reduced sensation up to right ankle
　
　
[amended >>]ECG: SR noa cute ischemic changes[<< amended]　
　
Plan: (s/b Dr Zaidi)
to rpt ECHO at Sg Buloh UiTM today
TCA Cardio x1/12
cont captopril and metoprolol - already have a one months supply
TCA nearest hospital if condition worsen
　
　
Zahirah

70 years old lady
　
　
kc
HPT
DM
non smoker, no alcohol
FHx:
3/4 siblings
all brothers and sisters have DM/ HPT
one brother died from CCF
father - has DM/ HPT/ IHD/ CVA
mother - no known medical illness
　
　
Medications: No allergies
Aspirin 150mg OD
Plavix 75mg OD
Frisemide 20mg OD
Glicazide 40mg BD
Metformin 1g BD
Isosorbide dinitrate 10mg TDS
Simvastatin 20mg ON
Trimetazidine 2mg TDS
　
　
referred from HSB for angiogram
　
　
Admitted to HSB on 27/9/2011 for Unstable angina
presented with sudden onset of heavybess oveer the central chest at rest a/w giddiness and sweating
　
　
blood Ix at HSB:
FBC - wcc 9 hb 13.6 plt 307
RP: Ur 4.6 Na 138 K 4.2 Cr 49
FBS: 7.2
Hba1c 10.6%
TFT - T415 TSH 1.03
TG 1.31
LDL 3
HDL 1.16
Tot chol 4.78
　
　
Hep Bs Ag non reactive
Hep CV Ab non reactive
HIV non reactive
　
　
ECHO @ 29/9/2011:
Chambers size: normal sizes
LV contraction: Bradycardia
Valve morphology: mild tricuspid regurgitation with PASP 22mmhg
LVH/ ASH/ SAM: LVH 1.6cm
Conclusion: EF 56%
　
　
Since discharged from HSB, no more chest pain/ SOB/ leg swelling
c/o neck pain under physio for ? cervical spondylosis
　
　
OE:
alert
pink
not tachypneic
Lungs: clear
CVS: HS I + II + no added sounds
no pedal edema
　
　
ECG - SR, T inv I, aVL, V2 - V6
　
　
Plan: (s/b Dr Zubin)
for angiogram on 1/11/2011 - pt agreeable
for GSH
keep NBM after light breakfast @ 6am
withold OHA prior to angiogram - pt informed
consent form signed
TCA cardio clinic after angiogram
　
　
Zahirah
　Cardio clinic check list:
1) Explore and address the pt's general complaints
2) Explore pt's ICE
3) Explore and address pt's complaints specific to his condition
4) Explore pt's drug compliance
5) Explore any drug side effects
     -minor side effects: reassure, provide symptomatic relieve and encourage pt to continue treatment
                                  if still not relieved, withraw the tx
     -major side effects: ask specifically about drug toxicity
6) Reinforce pt's knowledge on TB and TB Tx
7) Safety Netting