USMLE Forum Archives - USMLE Step 2 CK - A 56-year-old white male
A 56-year-old white male
meduploader - 05-07-09 14:01
A 56-year-old white male presents with dyspnea for the last 3 months. His dyspnea was initially exertional but it has worsened progressively and now he is breathless even at rest. He denies any chest pain or ankle swelling. He has been smoking one-pack/day cigarettes for the last 30 years and has been drinking alcohol heavily for the last 10 years. He is not taking any medication. His mother died of breast cancer at 57. His vitals are, PR: 86/min, BP: 113/76mm of Hg; Temperature: 37.1C(98.9F); RR: 13/min. On auscultation of his precordium an S3 is heard, but there are no murmurs. Chest auscultation reveals bilateral basal crepitations. Chest x-ray shows marked cardiac silhouette enlargement and pulmonary venous congestion. EKG shows non-specific ST-T wave changes. Echocardiography shows a dilated left ventricle and systolic dysfunction (EF of 25-30%). CBC shows hematocrit of 32%, WBC count of 6,000/microL, and platelet count of 60,000/microL. Peripheral blood smear shows MCV of 101 fL. LFTs show AST of 180U/L and ALT of 66 U/L. The findings of cardiac catheterization and coronary angiography are not compatible with the diagnosis of ischemic cardiomyopathy. Which of the following measures is most likely to reverse his heart failure?
meduploader - 05-07-09 14:01
A 56-year-old white male presents with dyspnea for the last 3 months. His dyspnea was initially exertional but it has worsened progressively and now he is breathless even at rest. He denies any chest pain or ankle swelling. He has been smoking one-pack/day cigarettes for the last 30 years and has been drinking alcohol heavily for the last 10 years. He is not taking any medication. His mother died of breast cancer at 57. His vitals are, PR: 86/min, BP: 113/76mm of Hg; Temperature: 37.1C(98.9F); RR: 13/min. On auscultation of his precordium an S3 is heard, but there are no murmurs. Chest auscultation reveals bilateral basal crepitations. Chest x-ray shows marked cardiac silhouette enlargement and pulmonary venous congestion. EKG shows non-specific ST-T wave changes. Echocardiography shows a dilated left ventricle and systolic dysfunction (EF of 25-30%). CBC shows hematocrit of 32%, WBC count of 6,000/microL, and platelet count of 60,000/microL. Peripheral blood smear shows MCV of 101 fL. LFTs show AST of 180U/L and ALT of 66 U/L. The findings of cardiac catheterization and coronary angiography are not compatible with the diagnosis of ischemic cardiomyopathy. Which of the following measures is most likely to reverse his heart failure?
The correct answer and explanation will be available after you answer.
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#13
Re: A 56-year-old white male crazyserb - 06-14-09 19:29 My answer is: b.
AST/ALT is more than 2:1 ... alcohol related cardiomyopathy
#46
Re: A 56-year-old white male babbu5508 - 05-21-10 14:48 My answer is: b.
Alcoholic cardiomyopathy is a disease in which the chronic long-term abuse of alcohol leads to heart failure.[1] Alcoholic cardiomyopathy is a type of dilated cardiomyopathy. Due to the direct toxic effects of alcohol on heart muscle, the heart is unable to pump blood efficiently, leading to heart failure.
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