Patient Studies in Valvular, Congenital, and Rarer Forms of Cardiovascular Disease

Franklin B. Saksena, MD, CM, FACP, FRCP(C), FACC, FAHA and member of American Society of Echocardiography. Dr. Saksena served as a Senior Attending Physician in the Department of Cardiology at Stroger Hospital of Cook County, Chicago for over 32 years. He remains active at Stroger Hospital of Cook County as a Voluntary Attending Physician in Adult Cardiology. While working for Cook County Hospital he was Director of the Cardiac Catheterization lab and for a period was Acting Chief of Cardiology. Dr. Saksena is currently an Associate Professor of Clinical Medicine at Northwestern University and an Assistant Professor of Medicine at Rush Medical School. He also maintains a part-time private practice in Cardiology and Internal Medicine at Swedish Covenant Hospital and St. Mary of Nazareth hospitals.

About the Author vii Preface  ix

Acknowledgments  xi

Abbreviations xiii

Worked Example  xv

Companion Website  xix

Patient Study 1 46-year-old chronic alcoholic man with heart failure and sudden death (1968)  1

Patient Study 2 24-year-old man with dyspnea, edema, and a heart murmur (1973)  7

Patient Study 3 27-year-old man with hemoptysis and dyspnea (1973)  19

Patient Study 4 22-year-old female with exertional chest pain and palpitations (1974)  23

Patient Study 5 40-year-old man and the perils of walking in the street (1997)  30

Patient Study 6 54-year-old man with dyspnea and a lifelong murmur (1974)  37

Patient Study 7 26-year-old man with an asymptomatic heart murmur (1979)  44

Patient Study 8 20-year-old man with chest pain and a life-long heart murmur (1979)  50

Patient Study 9 23-year-old female with heart failure and a heart murmur (1975)  59

Patient Study 10 17-year-old man with fever, myalgias, and a heart murmur (1977)  71

Patient Study 11 24-year-old man with left leg pain (1977)  80

Patient Study 12 48-year-old female with dyspnea (1976)  87

Patient Study 13 19-year-old man with easy fatiguability, cyanosis, and clubbing (1977)  93

Patient Study 14 29-year-old man with an asymptomatic murmur and an abnormal chest X ray (1977)  100

Patient Study 15 32-year-old man with a history of dyspnea and syncope over last 38 years (1967)  107

Patient Study 16 55-year-old female with chest pain and hematemesis (1993)  120

Patient Study 17 27-year-old man with decreased exercise tolerance and a heart murmur (1982)  126

Patient Study 18 29-year-old man with pleuritic chest pain, dyspnea, and cardiomegaly (1985)  135

Patient Study 19 25-year-old man with new onset of hemoptysis (1986)  142

Patient Study 20 80-year-old man with hemoptysis and dyspnea (1998)  149

Patient Study 21 21-year-old man with hemoptysis, cyanosis, and a heart murmur (1989)  157

Patient Study 22 23-year-old female with chest pain and visual symptoms (1992)  167

Patient Study 23 Approximately 40-year-old man with new onset of a murmur and heart failure (1975)  173

Patient Study 24 54-year-old female with altered mental status (1993)  182

Patient Study 25 74-year-old female admitted with abdominal pain followed by shock (1994)  187

Patient Study 26 Approximately 82-year-old female admitted with recurrent lower GI bleeding and a known abdominal aortic aneurysm (2001)  191

Patient Study 27 41-year-old female with chest pain and a heart murmur (1994)  197

Patient Study 28 48-year-old man with leg numbness and weakness (1994)  201

Patient Study 29 67-year-old female with chest pain and a new heart murmur (1995)  208

Patient Study 30 62-year-old man with chest pain and hypertension (1996)  214

Patient Study 31 17-year-old female with fatigue and a heart murmur (1997)  219

Patient Study 32 31-year-old female with fatigue and syncope (1997)  224

Patient Study 33 33-year-old female with dyspnea, edema, and a murmur (1995)  231

Patient Study 34 21-year-old man with dyspnea and chest pain (1995)  238

Patient Study 35 54-year-old man with chest pain, hypertension, and abdominal pain (2005) 245

Patient Study 36 19-year-old female with aching legs on exertion (1995)  249

Patient Study 37 58-year-old man with dyspnea, chest pain, and Sjorgen’s syndrome (1996)  256

Patient Study 38 37-year-old ex cocaine user with dyspnea and a heart murmur (1998)  261

Patient Study 39 24-year-old female with a heart murmur (1997)  266

Patient Study 40 34-year-old Asian female with heart failure(2001)  272

Patient Study 41 73-year-old man with chest pain and hypertension (2000)  278

Patient Study 42 42-year-old female with dyspnea and a heart murmur (2001)  283

Patient Study 43 37-year-old female with dyspnea and cyanosis (1999)  289

Patient Study 44 27-year-old female with dyspnea, a murmur, and kyphoscoliosis (1996)  296

Patient Study 45 41-year-old man with presumed cardiomyopathy (2002)  302

Patient Study 46 78-year-old female with chest pain and a heart murmur (2002)  310

Patient Study 47 31-year-old man with long-standing clubbing (1997)  317

Patient Study 48 79-year-old man with dyspnea and edema 3 years after an operation (1995)  328

Patient Study 49 37-year-old female with recurrent syncope and heart failure (1984)  336

Patient Study 50 33-year-old man with new onset of hemiplegia (1985)  342

Patient Study 51 44-year-old female with chest pain and dyspnea (2008)  345

Patient Study 52 80-year-old diabetic female with an abnormal echocardiogram and no CVS symptoms (2008)  352

Patient Study 53 42-year-old female with palpitations and an abnormal echocardiogram (2006)  355

Patient Study 54 53-year-old alcoholic man and the perils of winter (2009)  360

Patient Studies 55–56 90-year-old female with dyspnea and hemoptysis (2000)  366

Patient Study 57 1-month-old Infant with unsuspected cardiac pathology on echocardiography (2002)  372

Patient Study 58 69-year-old man with lower extremity pain (2008)  374

Patient Study 59 71-year-old man with dizziness and weakness (2010)  379

Patient Study 60 20-year-old man with pleuritis and fever (1995)  383

Patient Study 61 20-year-old man with swollen face and chest pain (2008)  389

Patient Study 62 17-year-old female with an acute myocardial infarction (2013)  395

Patient Study 63 66-year-old diabetic female with ICD dysfunction (2008)  401

Patient Study 64 39-year-old man with chest pain and syncope (2011)  406

Patient Study 65 58-year-old female with dyspnea, hypertension, and hematuria (2008)  413

Crossword Puzzle Pediatric cardiology and general medical crossword puzzle  419

Subject Index 421

Patient Studies Index 423

Disease Classification Index 425

Answers to Crossword Puzzle 427