Case 3

He has a history of hypercholesterolemia and hypertension.  Examination T: 37°C, P 85/min, BP 100/75. Systolic murmur, loudest over the aorta and peaking mid-systole. Palpitation of the carotid upstroke reveals a pulse that is both decreased and late relative to the apical impulse. Palpitation of the chest reveals apical impulse that is laterally displaced. Lungs are clear, and there are no rales.  Laboratory studies ECG: left axis deviation by no abnormalities in the ST segment. Chest radiography: enlarged left ventricle, and calcification of aortic valve. Doppler sonography: greatly increased velocity of flow during systole. Left atrium and ventricle chambers are enlarged, and left ventricular hypertrophy is present. Cardiac enzymes: CK-MD, troponin I, myoglobin levels are normal. 1) Describe what hypercholesterolemia is (origin, organs, types), and describe how this affects cardiovascular function.  2) Describe possible causes of hypertension.  3) Describe the various segments and meaning of the ECG. 4) What is syncope? 5) What is the significance of the left axis deviation, lateral displacement, and enlarged ventricular chamber?  6) What is the relevance of the cardiac enzymes measured?  7) The palpitation of the carotid and chest were abnormal. What is normal, and how do the observations help you with your diagnosis. 8) What is your diagnosis, and what is the treatment protocol.

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