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Dr. Khurram Irshad
Case history
Profile: Jamaluddin is a 57-year-old male who presents to the
ER.
Presenting Complaint:
Shortness of breath and swollen feet for 4 to 6 weeks.
History
of
Present
Illness:
Mr. Jamaluddin has been
experiencing progressive shortness of breath with exertion
for about the past four to six weeks. At first he tried to
ignore the dyspnea, but it has not gone away. He reports that
his dyspnea is most pronounced when climbing stairs or
walking up hill. The past few days he has also noticed a very
rapid and irregular heart rate, as well as some chest pain.
Now he describes being short of breath even at rest. He
states that his rapid heart rate is making him “very
uncomfortable”. He had no history of high blood pressure,
heart disease, or “palpitations” prior to the onset of these
symptoms several weeks ago.
Past Medical History: hypercholesterolemia; low back pain and
cervical dorsal strain/sprain
Personal History:
 Diet:
 Exercise:
 Sleep patterns:
 Nicotine use:
eats a fairly balanced diet
follows no particular exercise plan
sleeps no more than 5 hours per night
smokes 20 cigarettes/day
Family Medical History: His mother passed away from a stroke
at age 70, and his father died of an abdominal aortic
aneurysm at age 75. He denies any other significant family
history.
 Social History and Lifestyle: He works 70-80 hours per week
as a police officer. He eats two meals a day, he tends to
catch a snack where he can.
 Review of Systems
 Psychiatric History
 The patient claims to have high levels of stress due to shift
work, extended work hours, lack of adequate sleep, and back
pain.
Physical Examination
 JVP raised
 Pitting edema +++
 Apex beat shifted
 Tendor hepatomegaly
Cardiac cycle


1.
2.
Cardiac Cycle
Cyclical sequence of events beginning from one
cardiac contraction to next
Phases of cardiac Cycle
Systole
Diastole
 What will be the duration of one Cardiac Cycle if
Heart rate is 70 beats per minute?
Ventricular Systole
Ventricular diastole
Cardiac Cycle
Compliance of blood vessels
Aortic Pressure Curve