Case history
Case history #1
A 70-year-old woman complains of increasing exertional dyspnea for the last 2 days and now has dyspnea at rest. She has a history of hypertension for the last 5 years and a 35 pack-year smoking history, but no other established illnesses. Current medications are hydrochlorothiazide daily for the last 3 years. She has been prescribed lisinopril but failed to fill the prescription. On examination her BP is 190/90 mmHg, heart rate 104 bpm. There is an audible S4 and the jugular venous pressure is elevated 2 cm above normal. Lung examination reveals fine bibasal crepitations. There is no ankle edema. Echocardiogram shows an ejection fraction of 60%.
Case history #2
A 73-year-old woman with a history of myocardial infarction presents to the emergency department. She is breathless and finding it difficult to talk in full sentences. On examination she is centrally cyanosed with cool extremities. Her pulse is 110 bpm and systolic BP only just recordable at 80 mmHg. Jugular venous pressure is elevated 3 cm above normal and the cardiac apex beat is displaced. Respiratory rate is increased and she has widespread crackles and wheezes on chest exam. Echocardiogram shows an ejection fraction of 35%.
Other presentations
Patients may present with predominant symptoms of the underlying condition such as chest pain with acute myocardial infarction, syncope with significant valvular stenosis, palpitations with arrhythmias, and viral prodrome with myocarditis.
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