Case Studies:
There will be five case studies in the course designed for critical thinking in a clinical situation. A clinical scenario will be presented each week and you will be asked to interpret the data, explain the process and related concepts. A minimum of three APA citations for references should be used to complete the case study. A case study grading rubric will be included with each case study.
Case Study:
Mrs. Porter is a 72-year-old white female who presents to the office complaining of several weeks of worsening exertional dyspnea. Previously, she had been able to work in her garden and mow the lawn, but now she feels short of breath after walking 100 feet. She does not have chest pain when she walks, although in the past, she has had episodes of retrosternal chest pressure with strenuous exertion.
Once she felt lightheaded, as if she were about to faint, while climbing a flight of stairs, but the symptom passed after she sat down.
Recently, she also has been having some difficulty sleeping at night and has to prop herself up with two pillows. Occasionally, she wakes up at night feeling quite short of breath, which is relieved within minutes by sitting upright and dangling her legs over the bed. She has also noticed that her feet have become swollen, especially by the end of the day.
PMH: Denies any significant past medical history. No rheumatic fever. Takes no medication. No allergies.
PSH: No surgeries.
Past family history (PFH): Unknown.
SH: She doesn’t smoke or drink alcohol and prides herself on the fact that she hasn’t seen a healthcare provider in years.
Physical Exam
Vital Signs: BP 112/92, HR 86 (regular), RR 16, afebrile.
HEENT: Pink mucosa without pallor, normal thyroid gland, distended neck veins.
CV: Normal S1, second heart sound that splits during expiration (reverse splitting), + S4 at the apex, nondisplaced apical impulse, and a systolic murmur at the right upper sternal border that radiates to her carotids. The carotid upstrokes have diminished amplitude.
Lungs: Bibasilar inspiratory crackles.
Questions:
What additional assessment information do you need to make an accurate diagnosis?
Identify the differential diagnoses for this case?
Based on the data presented above what (in your opinion) is the most likely working diagnosis?