器官移植临床案例分析一

CaseNum213

PtName Heidi Maryam

Address2202 SW Sam Jackson

Age59

Height6' 0"

Weight198 lb

Sex F

Race White

Allergies NKDA

SectionName Organ Transplantation

CaseName Cardiac Transplantation

ChiefComplaint Orthotopic heart transplantation

HxPresIllness HM is a 59-year-old Caucasian female with a history of viral cardiomyopathy diagnosed approximately in 1999. She has had progressive heart failure over the past 2 years with shortness of breath, edema, and severe limitation of activity and is currently maintained on dobutamine and nitroprusside. Attempts to wean off of her inotropic support were unsuccessful. Patient was listed and considered for heart transplantation 3 weeks ago. Past medical history is significant for severe depression, gout, and herpes zoster. After finding a suitable donor, patient underwent heart transplantation for viral cardiomyopathy.

PastMedicalHx

Unstable angina

Status post cerebrovascular accident

Anemia

Depression

Ingrown right first toenail

Gout

Herpes zoster

Ventricular arrhythmia

SocialHx Smoking for 20 years
No illicit drug use
Married with five children

FamilyHx Her mother and father are alive, and she has no family history of viral cardiomyopathy or MI.

ReviewOfSystems The patient denies any fever, chills, back pain, dizziness, weakness, chest pain, shortness of breath, or rash. She does have fatigue. No symptoms of gastroesophageal reflux, dysphagia, odynophagia, lower extremity edema, or gastrointestinal bleeding. She does have occasional lower extremity paresthesias. No abdominal bloating or cramping. The remainder of her review of systems is noncontributory.

PhysicalExam A 59-year-old female in no acute distress. Vital signs are stable. Blood

pressure 158/79 mmHg, heart rate 93, respiratory rate 20, temperature 37.1. Oxygen saturation at room air is 98%.

Postoperative heart transplant day 2

CHEST: Respirations are even and unlabored

LUNGS: Clear to auscultation. No accessory muscle use noted. No retractions noted. CARDIAC: S1, S2, irregular rate and rhythm irregular, rubs and significant gallops

GI: Bowel sounds are present. No masses or organomegaly noted.

EXTREMITIES: There is noted lower extremity pitting edema bilaterally, which the patient states is her norm. Dorsalis pedis pulses 2+ bilaterally.

NEUROLOGIC: Without asterixis. She has no focal neurological deficits.

LabsAndDxTests

Sodium 141 mEq/L

Potassium 4.1 mEq/L

Chloride 102 mEq/L

CO2 24 mEq/L

Glucose 99 mg/L

Albumin 3.7 g/L

HCT 41%

Hemoglobin 10.6 g/dL

Diagnosis Heart transplantation

RxRecord

RPhNotes None available

CaseNum213

QuestNum2121

Question Which two agents act by inhibiting the enzyme calcineurin, which is needed for T-cell activation?