Stretching out

Cardiovascular System

Step 1: View Clinicals

{"ops":[{"insert":"A 44-year-old man presents with worsening exertional dyspnea and fatigability for 6 months, which has now progressed to dyspnea at rest. He also complains of orthopnea and paroxysmal nocturnal dyspnea but is otherwise asymptomatic.\u00a0","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n\n"},{"insert":"His medical history is unremarkable. There is no family history of cardiac disease. He is a very heavy drinker, having consumed around 10 drinks per day for the last 20 years.\u00a0","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n\n"},{"insert":"A full blood count is significant for a platelet count of 140,000\/mm3 (normal: 150,000-400,00) and a MCV of 101 fL (normal: 75-95). A liver profile is significant for an AST of 55 IU\/L (8-48), ALT of 65 IU\/L (7-55), and INR of 1.3 (normal: 0.9-1.1).","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-226_en.png"}},{"insert":"\n"}]}

Step 2: Order Relevant Investigations

1. ECG + Echocardiogram
2. HIV & Lyme disease antibodies
3. ESR & ANA
4. Thyroid profile

Step 3: Select Appropriate Management

1. Diuretics
2. Thiamine
3. Anticoagulation
4. ICD implantation

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