Case - 2

Presented By:
Aliah Aba-Alkhaill
Dua’a Al-Nasser

Ghezlan Al-Enizie

Hera’a Al-Naseem
Maryam Hassan
Ohood Al-Ostath
 CPC – 2
History
Mr. A. D. is a 65-year-old man who works
as an accountant in a local company. He
presented to the hospital emergency
doctor complaining of:

Cough 5 days
Difficulty in breathing 5
days
Chest pain 1 day
Generalized weakness 20
 CPC – 2
Past Medical History

The patient gave a history of :

•systemic hypertension but he

refused to take any drug
treatment

•heavy tobacco smoking for 20

yrs
 CPC – 2
Physical Examination
• The patient was an elderly
• He appeared very ill
• He had pale, cold and sweaty
hands
and face and was breathing
with
difficulty
• He was coughing frequently

The doctor decided to admit him

 CPC – 2
Admission to Hospital

The following data were obtained on

admission to hospital:

BP 90 / 50 mmHg
Pulse rate 120 / min
Temperature 37.5 o C
Respiratory rate 30/min
24 hr urine output 300 ml
 CPC – 2
Clinical Chemistry Serum
Fasting Glucose : 14.mmol/L
(3.9-6.1)

BUN : 15.0 mmol/L (2.5 -

6.6)

Creatinine : 220 mmol/L (60 -

120)

Na : 130 mmol/L (135 -

148)

K : 5.5 mmol/L (3.5 -

5.3)

Ca : 2.05 mmol/L (2.2 -

2.6)
 CPC – 2
Clinical Chemistry Serum
Alb : 30 g/L (35 - 47)

glob : 30 g/L (25 - 40)

T Bil : 27 mmol/L (3 - 20)

ALP : 80 IU/L (26 - 88)

ALT : 71 IU/L (10 - 60)

AST : 56 IU/L (10 - 41)

LD : 188 IU/L (90 -

180)

CRP : 150mg/L (<10)

Creatine kinase : 1450U/L

(20 – 250)

Urinalysis : glucose ++
 CPC – 2
Post-mortem Examination

The main pathological changes

were noted within:

Heart Aorta

Lungs Kidneys
 CPC – 2
Q1:
What kind of a disorder will
explain the:
Skin changes (pale, cold, and
sweaty)?
Peripheral vasoconstriction

Pulsedisease
Cardiac rate (high)?
(failure)

Renal
24 disease (so fluids
urine output conserved)
(low)?
 CPC – 2
Q2:
What term is used to describe:

Increased pulse rate?

Tachycardia

Increased respiratory rate?

Tachypnea

Difficulty in breathing?
Dyspnea
 CPC – 2

Q3:
In the following pictures,

What is the main abnormality in

the lungs in this patient?

(Figs. 3A, B, C, & D)

 CPC – 2

Q4:

What changes do you see

in the heart?

(Figs. 4A, B, C & D)

 CPC – 2
Q5 & Q6:

What causes the vacuolar

changes seen
in the tissue adjacent to the
infarct?

What are the morphological

characteristics of coagulative
 CPC – 2
Q7:

What is the abnormality seen

in the kidney of this patient?

(Fig.7a & 7B)

 CPC – 2
Q8:

What factors do you think underlie

the cardiac abnormality in this patient?

atherosclerosis
Hypertensi Coronary Artery Disease
on, contractility↓ MI
Smoking,
65 yrs old
CHF
cardiogenic shock
 CPC – 2

Q9:
Based on the above can you
explain
the cause of the lung
pathology in
Left heart failure will lead to
this pulmonary
patient? hypertension,
resulting
in congestion and pulmonary
edema
 CPC – 2
Q10:

Find two reasons in this patient to

explain the urine output result

• Hypoperfusion (due to
vasoconstriction)

2.Acute tubular necrosis

 CPC – 2
Q11:
Explain the clinical chemistry results in this
patient
Fasting Glucose : 14.mmol/L
(3.9-6.1)

BUN : 15.0 mmol/L (2.5 -

6.6)

Creatinine : 220 mmol/L (60 -

120)

Na : 130 mmol/L (135 -

148)

K : 5.5 mmol/L (3.5 -

5.3)

Ca : 2.05 mmol/L (2.2 -

2.6)
 CPC – 2
Alb : 30 g/L (35 - 47)

glob : 30 g/L (25 - 40)

T Bil : 27 mmol/L (3 - 20)

ALP : 80 IU/L (26 - 88)

ALT : 71 IU/L (10 - 60)

AST : 56 IU/L (10 - 41)

LD : 188 IU/L (90 -

180)

CRP : 150mg/L (<10)

Creatine kinase : 1450U/L

(20 – 250)

Urinalysis : glucose ++
 CPC – 2

Q12: What is the final

diagnosis
in this case?
“Cardiogenic Shock
complicated by
Acute Tubular
Necrosis”
An interview with a patient suffered
from cardiogenic shock