From the subjective data collected through history taking and objective data gathered from the physical assessment of Mr Jones, the primary differential diagnosis was AR. During auscultation, the murmur of aortic regurgitation is complicated. The left ventricle is typically dilated secondary to extreme volume overload, as it must handle both the forward flow delivered from the left atria as well as the backflow of blood from the aorta. As the damage progresses, the symptoms can appear suddenly. The abnormal backflow of blood leads to pathologic changes in the heart in order to compensate for the decreased successful cardiac output . Aortic regurgitation occurs from either damage to the aortic valve leaflets or dilation of the aortic annulus (Otto, …show more content…
Symptoms are generally radical and usually exacerbated by a racing heart palpitations, dizziness , fainting, fatigue and shortness of breath on exertion . The other differential diagnosis were right heart failure , symptoms includes the lower extremity oedema. When the legs are elevated at night, the fluid redistributes centrally causing pulmonary edema resulting in orthopnea or paroxysmal nocturnal dyspnea ( Otto,2014) . Another differential diagnosis is the bicuspid aortic valve disease , this type of valve has only two leaflets ,with this deformity, the valve doesn’t function perfectly, but it may function adequately for years without causing symptoms or obvious signs of a problem(Otto, 2014). These differential diagnoses were discussed and explained to the patient and family as well as with the multidisciplinary team who recognized that these diagnoses were suitable in the situation of Mr
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
The most likely diagnosis for the cardiac murmur in this horse is aortic insufficiency, as a result of degenerative changes to the aortic valve. In aortic insufficiency, the murmur heard is due to regurgitation through the defective aortic valve. Aortic insufficiency presents clinically with a holodiastolic decrescendo murmur, with maximal intensity over the aortic valve7, as is heard in this case. Holodiastolic means that the murmur is occurring between the end of S2 and the beginning of S1. Decrescendo refers to a murmur that gradually declines during diastole, as the pressure gradient between aorta and left ventricle drops, as a result of run-off into the systemic circulation and the ventricle. The murmur is often musical or honking in nature7. This is a common finding in older horses4, and the most common acquired valve lesion7, usually of little clinical significance.
“When Doctors Make Mistakes” narrates an event where the author Atul Gawande, a doctor, made a mistake that cost a women her life. He relates that it is hard to talk about the mistakes that occurred with the patient's family lest it be brought up in court. In that instance the family and doctor are either wrong or right, there is no middle ground in a “black-and-white mortality case”(658). Even the most educated doctors make simple mistakes that hold immense consequences but can only speak about them with fellow doctors during a Morbidity and Mortality Conference.
Nishimura, R. A., & McGoon, M. D. (1999). Editorial: Perspectives on mitral-valve prolapse. The New England Journal of Medicine, 341(1), 48-50. Retrieved from http://search.proquest.com/docview/223939414?accountid=158514
Darien is a patient who possibly displays comorbidity. His symptoms lead me to believe that he could possibly be diagnosed with obsessive-compulsive disorder and generalized anxiety disorder. Darien’s symptoms that point to OCD are that he has rituals he must complete and if he does not he becomes anxious and is unable to continue with his day. He is however aware that these rituals are not actually helping him but he cannot stop doing them. He also reports feeling anxious most of the day, especially if he cannot perform his rituals, and that he is becoming increasingly more anxious. He is also unable to keep himself from worrying and feeling anxious.
Sever Aortic Stenosis (AS) is a major cause of mortality and morbidity in elderly duo to a bimodal age distribution ,degenerative calcification of Tricuspid valve is the major cause of AS in the population ,unlike the younger patient etiology which is : bicuspid valve calcification or rheumatic heart disease .1
Heart disease is the leading cause of death in the United States and the estimated cost of treatment is $32 billion yearly. Approximately 5 million people living in the United States suffer from congestive heart failure (CHF) and half of those diagnosed will die within 5 years. An individual may present to the hospital with weakness, short of breath (SOB), swelling of the extremities, ascites, and breathing difficulties while lying down. The quality and length of life for someone suffering from heart failure can be improved with early diagnosis, medication, physical activity, and diet modification (CDC, 2013).
These causes will change the heart significantly. The pathophysiology of heart failure is described differently as: (1) an oedematous disorder, by means of which the deviations in renal hemodynamics and excretory ability lead to salt and water holding; (2) a hemodynamic disorder, considered by peripheral vasoconstriction and decreased cardiac output; (3) a neurohormonal disorder, mainly by stimulation of the renin-angiotensin-aldosterone system and adrenergic nervous system; (4) an inflammatory syndrome, related with amplified local and circulation pro-inflammatory cytokines; (5) a myocardial disease, started with an damage to the heart trailed by pathological ventricular transformation. In heart failure, the heart sustains either a sudden or longstanding structural injury. When damage occurs, sequences of firstly compensatory but consequently maladaptive mechanisms follow (Henry & Abraham, ).
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
`In the past, I worked in such a research setting, where if a person was found to meet criteria for opiate dependence they received treatment, however if even slightly short of DSM-IV criteria for the disorder they would have to look elsewhere. This was a continual concern for me, as the person who met criteria was not always the person with the most distress, and alternative treatments were not easy for people to find. Largely from this experience, I find the current categorical approach to classifying persons with psychopathology to be an imperfect system at best, with the primary advantage of being convenience when communicating with other professionals. I question whether this convenience comes at a severe cost to accuracy, the result of which is an artificial limit to the range of presentations that occur in psychopathology. As the example above illustrates, the particular aspect that I find most problematic is the use of cutoffs for specific symptoms, for instance the length symptoms must have been present for it to be classified as a disorder, or even the number of symptoms that need to be present. I think it is unlikely that a person who “almost” meets criteria for a disorder would be significantly different from a person with similar symptoms who just barely meets criteria. In private practice these two cases would likely be treated similarly, but in a setting where diagnosis serves as a screening tool the client who met criteria may get treatment while the other does not. In this case I feel that less specific guidelines, lacking specific numerical limits would alleviate many of the problems.
Glen Carver is a 56 year old male who was admitted unto the cardiovascular care unit 48 hours ago with the diagnosis of heart failure. Mr. Carver went to see his primary care provider with complaints of dyspnea on exertion, a nonproduction cough, decreased activity intolerance, and general fatigue all of which have been worsening over the past two months. The primary care provider found Mr. Carver to have lower extremity swelling, profound ...
Most often the disease starts in the left ventricle, and then often spreads to both the atrium and right ventricle as well. Usually there will also be mitral and tricuspid regurgitation, due to the dilation of the annuli. This regurgitation will continue to make problems worse by adding excessive volume and pressure to the atria, which is what then causes them to dilate. Once the atria become dilated it often leads to atrial fibrillation. As the volume load increases the ventricles become more dilated and over time the myocytes become weakened and cannot contract as they should. As you might have guessed with the progressive myocyte degeneration, there is a reduction in cardiac output which then may present as signs of heart failure (Lily).
Dual diagnosis is a term used to describe people who have a problem with or an addiction to drugs and/or alcohol and also have a mental illness such as depression or bipolar disorder. The relationship between substance abuse and mental illness is very complex because drugs and alcohol are often used as a kind of self-medication for people who suffer from mental disorders. Nearly 10 million Americans have co-occurring mental health conditions and substance abuse disorders (SAMHSA Report, 1996, Primm, n.d.). Research shows that those with a dual diagnosis result in worse or more undesirable outcomes than those with single diagnosis. Dual diagnosis is usually assessed by a very structured set of questions that help to assess any mental illness
As humans when we are faced with any psychological or emotional problems, our initial thought is to turn to a therapist, doctor or any other health practitioners. Our initial thought when we are faced with problems regarding our health is to turn to a health professional because for ages that’s how it has been. When it comes to our health, health professionals nowadays do more harm than help. Many might disagree, but often patients are misdiagnosed with mental illnesses they do not have. Misdiagnosis occurs when a therapist or other health practitioners decide that a patient is suffering from a condition that he or she may not be suffering with. When misdiagnosed, patients are given unnecessary treatment, which could potentially
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.