器官移植临床案例分析一.docVIP

CaseNum 213 PtName Heidi Maryam Address 2202 SW Sam Jackson Age 59 Height 6 0 Weight 198 lb Sex F Race White Allergies NKDA SectionName Organ Transplantation CaseName Cardiac Transplantation ChiefComplaint Orthotopic heart transplantation HxPresIllness HM is a 59-year-old Caucasian female with a history of viral cardiomyopathy diagnosed approximately in 1999. She has had progressive heart failure over the past 2 years with shortness of breath, edema, and severe limitation of activity and is currently maintained on dobutamine and nitroprusside. Attempts to wean off of her inotropic support were unsuccessful. Patient was listed and considered for heart transplantation 3 weeks ago. Past medical history is significant for severe depression, gout, and herpes zoster. After finding a suitable donor, patient underwent heart transplantation for viral cardiomyopathy. PastMedicalHx Unstable angina Status post cerebrovascular accident Anemia Depression Ingrown right first toenail Gout Herpes zoster Ventricular arrhythmia SocialHx Smoking for 20 yearsbrNo illicit drug usebrMarried with?five children FamilyHx Her mother and father are alive, and she has no family history of viral cardiomyopathy or MI. ReviewOfSystems The patient denies any fever, chills, back pain, dizziness, weakness, chest pain, shortness of breath, or rash. She does have fatigue. No symptoms of gastroesophageal reflux, dysphagia, odynophagia, lower extremity edema, or gastrointestinal bleeding. She does have occasional lower extremity paresthesias. No abdominal bloating or cramping. The remainder of her review of systems is noncontributory. PhysicalExam A 59-year-old female in no acute distress. Vital signs are stable. Blood pressure 158/79 mmHg, heart rate 93, respiratory rate 20, temperature 37.1. Oxygen saturation at room air is 98%. Postoperative heart transplant day 2 CHEST: Respirations are even and unlabored LUNGS: Clear to auscultation. No accessory muscle use noted. No retractions noted. CARDI