器官移植临床案例二.docVIP

 PAGE \* MERGEFORMAT 13 CaseNum 214 PtName Amy Farrah Address 10 SW Merlin Court Age 68 Height 5 11 Weight 125 lb Sex F Race White Allergies Codeine SectionName Organ Transplantation CaseName Cardiac Transplantation ChiefComplaint Transfer from St. Andrew Medical?Center in cardiogenic shock HxPresIllness AF is a 68-year-old woman with coronary artery disease admitted 10 days ago with chest pain for about 3 hours, diaphoresis, and shortness of breath, which was preceded by about 3 days of shortness of breath, dyspnea on exertion, wheezing, and orthopnea. On presentation, she was tachycardic and normotensive, and EKG revealed loss of R waves across the anterior precordium with no acute ST or T wave changes. Chest x-ray revealed pulmonary edema. Initial CK was 505. She was found to have normal renal function and normal hematocrit. An echocardiogram revealed anteroseptal akinesis, a laminar clot, posterior and inferior right ventricular hypokinesis, severe tricuspid regurg, and mild mitral regurg. She had a cardiac index of 1.4. The patient is on 100% nonrebreather mask while plans are underway for heart transplantation. PastMedicalHx CHF; going for HHTx today Parkinsons disease which is felt to be mild, managed only with Artane which controls a mild tremor Hiatal hernia Endometrial cancer GERD Severe kyphosis and scoliosis SocialHx She lives independently. She is married with very supportive family, church, and husband. She is active and drives. She is a retired secretary. FamilyHx Includes a history of coronary artery disease ReviewOfSystems VS: Temperature 37.5°C, blood pressure initially 155/85 mmHg, decreasing to 110-120/40-60, heart rate 85-90, respirations 10/10 on a ventilator She came with an intraaortic balloon pump 1:1. Initial Swan numbers revealed a cardiac index of 1.49, a cardiac output of 2.55, a CVP of 10, a pulmonary artery wedge pressure of 22, systemic venous resistance of 1474, anda pulmonary vascular resistance of 188 at the time of transfe