Kuiz SPOT DIAGNOSIS ACADEMIC MINUTE NO.1 NOV
A 33-year-old lady visited
the cardiologist because of the sudden death of her brother at age 35. He died
while watching TV and had been without symptoms as far as she was aware. Her
father received a pacemaker at the age of 48. She had no complaints of dizziness,
palpitations, dyspnoea or chest pain. Her only complaint was some weakness in
her arms shortly after lifting them to get something from above her head.
Physiological examination did not reveal any peculiarities. Her ECG is shown link . Her echocardiogram is normal, although cardiac dimensions were at the
upper limit of normal.
TAHNIAH
AHMAD MUSTAQIM
6TH YEAR GROUP 37
6TH YEAR GROUP 37
JAWAPAN:
working diagnosis : cardiomyopathy, to rule out inherited myopathy
ECG : shows normal sinus rhytm 60 bpm, low amplitude p at all lead, prolonged pq (>300msec), normal QRS.
basis of diagnosis : conduction abnormalities shown in the ecg and history of proximal muscle weakness(cannot raise arm above head) and FHx of early spontaneous unexplained death in 1st degree relative and another family member with a pacemaker raise suspicion of myopathy. US scan show upper border size of heart (maybe early stage of dilatative cardiomyopathy).
Plan Ix: genetic testing for myopathy, muscle biopsy, neuro consult, thoracic surgeon consult for ICD implantation (kiv), genetic counseling for family planning.
ahmad mustaqim
No comments:
Post a Comment