Case Files Internal Medicine by Eugene C. Toy, John T. Patlan Jr.

By Eugene C. Toy, John T. Patlan Jr.

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These patients can be recognized clinically as hypotensive, with markedly elevated jugular venous pressure but clear lung fields and no pulmonary edema seen radiographically (in contrast to the pulmonary edema seen 28 CASE FILES: INTERNAL MEDICINE in patients with hypotension to LV failure), and the diagnosis confirmed by observation of ST-segment elevation in a right-sided ECG. In this setting, RV function is impaired and highly dependent on adequate preload, so treatment requires support consisting of volume replacement with saline or colloid solution.

Ischemic heart disease. , eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012:1998-2015. Kushner FG, Hand M, Smith SC Jr, et al. 2009 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. Circulation. 2009;120:2271. Tatum JL, Jesse RL, Kontos MC, et al. Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med. 1997;29:116-125. CASE 2 A 72-year-old man presents to the clinic complaining of several weeks of worsening exertional dyspnea.

Diabetes B. Atherosclerosis C. Alcohol D. 3 A 75-year-old man is noted to have chest pain with exertion and has been passing out recently. On examination he is noted to have a harsh systolic murmur. Which of the following is the best therapy for his condition? A. Coronary artery bypass B. Angioplasty C. Valve replacement D. 4 A 55-year-old man is noted to have congestive heart failure and states that he is comfortable at rest but becomes dyspneic even with walking to the bathroom. On echocardiography, he is noted to have an ejection fraction of 47%.

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