临床病例讨论(汇总).docVIP

Case studies for cardiovascular disease Case 1 History: A ten-year-old girl presented with a mild sore throat. The pediatrician noticed some redness, swabbed her throat, tested for group A streptococci, sent blood for antistreptolysin O titer, and prescribed treatment. Three weeks later, the girl returned with fever and painful swelling of the knee joints, followed by pain and swelling of elbow joints. Physical examination showed a pericardial friction rub and a murmur suggestive of mitral regurgitation. The antistreptolysin O titer was elevated over the previous value. The girl was hospitalized and treated with antibiotics. She recovered and did well over the next several decades. In her thirties, the patient began to have dyspnea on exertion and occasionally awakened at night feeling short of breath. She had one fainting spell, followed by an episode of temporary loss of vision in one eye. On admission to the hospital, she was very short of breath and had coughed up some blood-tinged sputum. Physical examination and laboratory tests suggested narrowing of the mitral valve orifice. X-ray of her chest showed an enlarged left atrium and pulmonary edema. She was treated medically for several days and discharged, feeling better but with some residual limitation of cardiac function. The week before her next admission, she went to a dentist because of tooth pain, and underwent a dental extraction. She returned to the hospital with high spiking fevers and overt signs and symptoms of heart failure. Questions: 1. What is the significance of the history of rheumatic fever as a child? What are the primary symptoms of acute rheumatic fever? 2. What is the etiology of acute rheumatic fever? 3. Which valves are most likely to suffer damage? 4. Why is this patient feeling so short of breath? Why is her left atrium enlarged? Why are her lungs abnormal? Why does she get short of breath at night? Does she have heart failure? What kind? Objectives: 1. Describe the etiology of acute