Exercises in making a Clinical Diagnoses - Semester 10

Exercise 1

Presenting complaints: Worsening shortness of breath for 2 weeks

History of present illness:
Mr CCS, a 69-year-old Chinese gentleman, with underlying congestive cardiac failure secondary to ischaemic cardiomyopathy NYHA Class III presented with shortness of breath which worsen over 2-week duration. The shortness of breath even occurred at rest, thus limited his daily activities and disturbed his sleep. There were reduced effort tolerance, orthopnoea and paroxysmal nocturnal dyspnoea. Besides, the problem was associated with productive cough for two weeks, with whitish sputum. He did not experience any fever or chest pain. Other than that, he also complained of bilateral lower limb swelling for the past 1 month, which was relieved by raising those limbs up. Otherwise, he did not experience palpitation or giddiness. Since he was diagnosed with congestive cardiac failure, he was prescribed with multiple medications and advised on restriction of fluid of 500cc/day. He was compliant to medications prescribed but not to restriction of fluid. Normally, he would drink up to 1000cc of fluid per day due to warm environment.

Questions:

  1. What is the cause of this man’s presenting complaints?
  2. Is ischemic cardiomyopathy different from ischemic heart disease?
  3. What do you think is the cause of his cough for two weeks?
  4. Suggest possibilities for the physical findings in this patient regarding: a) Pulse b) Blood pressure c) Cardiac examination d) Respiratory examination e) Abdominal examination
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