Saturday, November 4, 2023

Conclusion Caturday: Elaine Emits Exhaustion (Case 3)

Picture of stuffed alpaca Professor Pocky and stuffed camel Douglas

Photo of TA Douglas (Left) and Professor Pocky (Right) taken by Dr. Haus
 

Click For Explanation of Case Flow

 

Click for Test Case Tuesday:  Elaine Emits Exhaustion

 

Click for Thoughtful Thursday:  Elaine Emits Exhaustion 

 

Quick Review


Diagnosis:

🌌DILATED CARDIOMYOPATHY🌌

 

Pathophysiological Point:

Elaine is suffering from a disease where her body's heart is stretching and weakening.  As the heart stretches and weakens, her heart is having a harder time pumping blood throughout her body.

 

 Questions, Answers, and Further Information:

 

Level 1 Questions, Answers, and Further Information:

  1. Explain what the heart does and why it is important.

    The heart is the pump that moves blood around the body.  The heart is important in making sure nutrients like oxygen get to the cells and waste materials like carbon dioxide are moved away from the cells.  The heart allows the body to survive.

  2. Why do you think Elaine's echocardiogram showed that all four (4) of her heart chambers are dilated compared to normal?  (HINT:  Think about Elaine's diagnosis)

    Elaine was diagnosed with Dilated Cardiomyopathy which means she has a disease where her heart muscle is weakening and dilating.  This means the heart chambers are becoming larger as the muscle weakens.  This is noted in the echocardiogram and is due to her weakened heart.

  3. Challenge question, why do you think Elaine collapsed in her habitat?  (HINT:  Think about the heart's job and how Elaine's heart is a diseased heart that is not working properly)

    Elaine likely collapsed in her habitat because her heart is so weak it cannot pump enough blood to the body.  If not enough blood is pumping to the body that means there is not enough oxygen getting to her body.  Elaine's brain relies on the heart pumping oxygen to it and if the blood is not pumping well there is not enough oxygen getting to Elaine's brain.  When there is not enough oxygen getting to the brain, the brain does not work correctly and Elaine collapses.

    Helpful Links:

 

Level 2 Questions, Answers, and Further Information:

  1. Explain why Elaine has an atrial arrhythmia.  (HINT:  Heart conduction system)

    Elaine has an atrial arrhythmia due to the weakening and dilation of her heart chambers due to her diagnosis of dilated cardiomyopathy.  As the muscles around the right atrium weaken and stretch, the conduction system in that area is stretched as well.  In the right atrium, there is the SA node that starts the process of conducting a heart beat.  If the right atrium is dilated and weakened, the SA node is stretched and will not give off its electrical signals correctly leading to an atrial arrhythmia.

  2. How could Elaine’s viral infection from 10 years ago lead to heart disease (HINT:  How might a viral infection in the blood affect the heart?)

    Elaine's previous viral infection could lead to her current heart disease as the virus in the bloodstream may have infected her heart muscle and destroyed some of her heart muscle cells.  Over the years, her heart has been needing to work harder to pump blood and her heart cells may have been overworked and were slowly dying.  As the heart cells are slowly dying, her heart is slowly weakening and dilating.

  3. Challenge question, explain pathophysiologically why Elaine has jugular vein distention, edema in the neck, and ascites on physical exam.  (HINT:  Think about the heart's anatomy and how Elaine's heart chambers are NOT able to pump blood effectively)

    Elaine has jugular vein distension, edema in her neck, and ascites due to the inability of her heart to effectively pump blood through the heart.  Since her heart is weakened, Elaine's heart is not able to pump the blood from the right atrium to the right ventricle to the pulmonary artery with as much efficiency.  This causes the blood to start backing up into the cranial/superior vena cava and caudal/inferior vena cava.  As the blood pools in these locations, water starts to leak out of the blood vessels.  This causes the edema in the neck and the ascites in the abdomen.  The jugular vein distension is due to the blood pooling in the jugular vein as the heart is not pumping as much blood as quickly through the heart.

    Helpful Links:

Level 3 Questions, Answers, and Further Information:

  1. Describe the treatment plan you would recommend for Elaine and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague.

    Elaine has been diagnosed with Dilated Cardiomyopathy (DCM) and there are countless treatments for heart diseases that depends on the patient's stage of disease, ability to administer treatments, and the goals for the patient's quality of life.  Some treatments for DCM might be changing the patient's diet if we believe there might be a dietary component, ACE inhibitors, Pimobendan, diuretics, anti-arrhythmic medications, etc.

    As a reminder, I am not an cardiologist and there are multiple correct answers to this question depending on the patient and the availability of care.  The important point to keep in mind is that with DCM we are prolonging the inevitable, there cannot cure the heart failure (unless we do a heart transplant).  We are keeping the patient's quality of life high through counteracting the negative side effects of DCM.

  2. Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.

    Today we have diagnosed Elaine with Dilated Cardiomyopathy.  This means Elaine's heart is slowly becoming weaker and weaker.  Elaine's weakening heart makes it hard for her to get all the oxygen she needs to her entire body.  At this time, we are going to start medications that will help Elaine pump blood through her body much more effectively.  We will keep Elaine on these medications as long as they are keeping her comfortable.  Unfortunately, there is not a cure for this condition so we will need to monitor Elaine's quality of life closely to determine the best plan for her care.

  3. Explain the pathophysiology of at least TWO (2) different etiologies of Dilated Cardiomyopathy.

    I am trusting you all to pick two etiologies of DCM and to explain the pathophysiology of them.  Be sure to view the helpful links below that will contain research articles diving into the pathophysiology of the potential causes of DCM.  it would also be interesting to look into the possible dietary links to DCM in dogs.

    Helpful Links:


Day 3 Conclusion

I hope you enjoyed Elaine's case!  Don't forget to...

📚 Review material related to Elaine's case 

🤩 Get excited for upcoming cases

Dr. Haus's Unsolicited Life Advice: 2nd thing you need to know to be a doctor: Blood goes round and round

at
Labels:

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)

Biking to Cape May - Getting Home

Photo by Dr. Haus The big part of the trip felt done when I arrived in Cape May and I spent four days enjoying Cape May in the off season.  ...