Do on your own
CVS case 1
A 55 year old woman had been complaining of chest pains on physical exertion relieved by rest. She was diagnosed to be suffering from ischemic heart disease. Part of her treatment included taking aspirin tablets daily. She noticed gastric pain on and off after starting aspirin but thought nothing of it. One day she suddenly vomited huge amounts of blood. On examination she appeared pale, heart rate was 100 beats per min and BP was 90 / 60 mm Hg lying down. On standing up, her heart rate was 140 beats per min and 75/50 mm Hg. Her hematocrit was 30% (normal = 35-45%). A gastroscopy was performed which showed a bleeding ulcer.
a) Explain how physical exertion caused chest pains in the patient.
b) Why was aspirin prescribed?
c) Comment on her heart rate and BP measured when she was lying down. Why did the doctor measure her heart rate and BP on standing up?
d) Why was the hematocrit lower than normal in this patient?
e) What concerns may arise from her low hematocrit?
f) From your answers to (c) (d) and (f), suggest one possible treatment for the patient. Give reasons for your suggestion.
CVS Case 2
A 70 year old man complained of “palpitations” and acute abdominal pain. He fainted after passing out bloody stools and was brought to the hospital. The heart rate was 140 beats / min and the pulse rate was 90 beats / min. The arterial pulse was described as irregular in rate and force. Blood pressure was 90 /60 mmHg. ECG done showed atrial fibrillation. Arteriography showed an embolus at the origin of the superior mesenteric artery. An operation was performed to remove the embolus.
a) Explain the discordance between heart rate and pulse rate
b) Explain the irregular rate and force of the peripheral arterial pulse
c) Give reasons why blood pressure was low despite the rapid heart rate.
d) Give a likely origin for the embolus. Explain your answer.
e) Suggest a possible treatment for the patient to prevent similar recurrences.