Cardiac anaesthesia
The sixty-five-year-old man was admitted to the hospital and hospitalized at the cardiology department for severe dyspnoea and stenocardia. He reports that he has symptoms since last year, but they have deteriorated markedly over the last three months. They usually manifest most after reaching the 2nd floor or walking about 150 m. Then he must stop and wait about 2 minutes until it relieves and he can continue. Syncopes are not reported. We get a complete medical history and perform a physical examination. What complications are currently the most life-threatening for the patient?
Help
MI as a result of long-lasting and fast-progressive IHD.
Left-sided heart failure and sudden death due to aortic stenosis.
Cor pulmonale and right-sided heart failure as a consequence of COPD development.
Interaction of the taken drugs in combination with smoking and metabolic syndrome could lead to increase of the plasma drug concentration and higher risk of side effects.
65
years
man
RR
19 /min
HR
86 /min
Examination
Past medical history: IHD, COPD, HT, AoS
Family history: father died at 65 due to AMI
Current medications: Tritace 5 mg, Stacyl 100 mg, FullHale, Torvacard 20 mg
Substances: one pack of cigarettes a day, alcohol occasionally
General: conscious, oriented, w/o dyspnoea at rest, icterus or cyanosis; BMI 30,5
Lungs: mild wheezing on expiration
Heart: muffled first sound, systolic murmur on the apex, knows about it, has been seeing his physician
LEs: w/o edemae, palpable pulsation in periphery
Glycaemia
Gly
4,4  mmol/L
Complete blood count
HGB
118  g/L
HTC
0,45
ERC
4,5  x1012/L
LEU
15,7  x109/L
PLT
250  x109/L
Biochemical analysis
Na
130  mmol/L
K
4,4  mmol/L
Cl
102  mmol/L
Mg
1,1  mmol/L
Ca
2,3  mmol/L
P
1,2  mmol/L
Glycaemia
Take a sample
Complete blood count
Take a sample
Biochemical analysis
Take a sample