The Dizziness Of The Long Distance Runner

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The Dizziness Of The Long Distance Runner - Page #3

Lab Studies: white blood cell count 12.6, hemoglobin 16.3, hematocrit 49.2, platelets 184,000. Sodium 138, potassium 3.3, chloride 108, bicarbonate 18, BUN 14, creatinine 1.1, glucose 100, calcium 8.3, magnesium 2.7, ALT 44, AST 57, alkaline phosphatase 107, albumin 4.4, total bilirubin 0.6, troponin T 81 ng/mL (reference range Other Studies: ECG: Normal sinus rhythm at 69 bpm. Mild right ventricular conduction delay. Diffuse J-point elevation suggestive of early repolarization Case Photo #1 . CXR: Normal Case Photo #2 . CT Angiogram of the chest: Negative for PE. No coronary calcifications seen. Echocardiogram: Normal right atrium, right ventricle, and left atrium. Normal left ventricle size, no hypertrophy. Normal ejection fraction (EF) greater than 52%. No wall motion abnormalities. Normal diastolic function. Normal valvular function. No atrial or ventricular septal defects or shunt. Consultations: Cardiology was consulted, and the patient was admitted for observation. Repeat labs on hospital day 1 demonstrated normalization of bicarbonate to 24, with an increase in ALT to 138 and AST to 140 followed by increase to 430 and 221, respectively, on hospital day 2. The remainder of the liver function tests remained normal. Repeat troponin at 6 hours was 203 ng/mL. Troponin decreased to 108 ng/mL at 12 hours and normalized to 22 ng/mL at 24 hours. Given the troponin trend suggestive of myocardial injury, the patient underwent cardiac catheterization, which revealed a tubular 50% lesion in the mid-left anterior descending (LAD) artery Case Photo #3 . The patient was then transferred to a tertiary care center for interventional cardiology. Repeat catheterization confirmed a moderate proximal LAD lesion. Intravascular ultrasound demonstrated evidence of a ruptured plaque with intramural hematoma. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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