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37 CASE 37


A 57-year-old man comes to the cardiovascular rehabilitation clinic to begin an exercise program.


The patient suffered a myocardial infarction 3 months earlier and had a drug-eluting stent inserted into a branch of the left anterior descending coronary artery. Imaging indicates a recovery of myocardial blood flow, and the patient is counseled to begin an exercise program to strengthen his heart. The patient is able to walk at a brisk pace for 20 minutes. In contrast, jogging or climbing stairs causes him to become short of breath.



PHYSICAL EXAMINATION



VS: T 37°C, P 80/min, R 17/min, BP 130/90 mm Hg, BMI 33

PE: Scars on the leg from catheters used to guide the placement of the stent are healed. There are some crackles heard at the base of both lungs on inspiration.

Chest radiograph: Fluid accumulation in the base of the lungs


LABORATORY STUDIES


The patient begins a cardiovascular stress test on a treadmill during which the speed and inclination of the treadmill are increased every 10 minutes. Heart rate is monitored through an electrocardiogram, arterial oxygen saturation is monitored through a pulse oximeter, and blood pressure is taken at regular intervals.


At low exercise intensity, arterial pressure increases to 140/85 mm Hg, heart rate increases to 120 beats/min, and respiratory rate increases to 30/min. Pulse oximetry decreased to 95%. After 10 minutes, an increase in exercise intensity causes little change in arterial pressure but pulse oximetry fell to 91%. Ten minutes later, intensity level was again increased, and the exercise was stopped after 2 additional minutes. Respiratory rate was 30/min and pulse oximetry was 89% when the patient was stopped from exercising. The patient was monitored for an additional 20 minutes during the recovery phase from exercise.



DIAGNOSIS


Exercise intolerance

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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 37

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