A 52-year-old diabetic man with myocardial infarction, pericarditis, and persistent fever

Article Abstract:

A 52-year-old male patient known to have diabetes which required insulin therapy for 20 years, and a more recently discovered elevation of cholesterol and other blood lipids was admitted to the Massachusetts General Hospital. Nine years prior to admission he suffered a myocardial infarction (heart attack) which was associated with typical electrocardiogram (ECG) changes and chest pain (angina). Three years prior to this admission, he experienced a period of angina and, although there were no changes in his electrocardiogram, changes in enzyme levels indicative of myocardial infarction were found in blood samples. The angina subsided and he returned to work with no further difficulties. On the day of the most recent admission, the patient had angina and developed difficulty breathing (dyspnea) while unloading trucks. He was sent to the hospital after consultation with his company nurse. His condition continued to worsen and although there was no irregularity of his heart or lungs initially by X-ray, an enlargement of the heart and pathological changes of the lungs were found by the sixth day of hospitalization. An abnormal chest sound, a pericardial rub, was heard; it suggests accumulation of fluid and involvement of the membranes surrounding the heart (pericardium). Ultrasound, a noninvasive method using soundwaves to visualize the heart, also documented these changes. His condition continued to worsen and, despite intensive intervention, the patient died. The article discusses at length the signs and symptoms of this case and evaluates possible therapies. The report of the pathologist confirmed the impressions of the clinical staff. The patient was found to have experienced an acute myocardial infarction of the posterior portion (back) of the heart. In the process the wall of the left ventricle eroded and ruptured and blood escaped into the pericardial space. Damage to the chordae tendineae ('heart strings' which keep the atrial ventricular valve from inverting) resulted in a poorly functioning valve in this chamber of the heart. Ruptures of the heart are responsible for five to 24 percent of all hospital deaths following myocardial infarction.

Diagnosis, Heart attack, Heart ventricle, Left, Left heart ventricle, Pericarditis, Yurchak, Peter M., Southern, James F.

---

A 3 1/2 year-old-boy with pharyngitis, fever, rash, and prominent cervical lymphadenopathy

Article Abstract:

The case history is presented of a boy aged three and one-half years old, who developed a throat inflammation (pharyngitis), fever, rash in the diaper area and swollen glands in the throat prior to hospitalization. At the age of two, he had been admitted to the hospital for treatment of pneumonia. Over the course of the first few days in the current illness, the mass in the patient's neck grew and the fever increased. The rash persisted and swelling of the soft tissues in the neck was noted. The patient developed signs of joint pain and became quite irritable, actively resisting examination by the fifth hospital day. The clinical diagnosis was Kawasaki disease (mucocutaneous lymph node syndrome), a condition associated with rash, fever, enlarged lymph nodes, and blood vessel inflammation. In this case, the coronary arteries (which supply blood to the heart) contained aneurysms, or irregular dilatations. The patient was treated with gamma globulin (which participates in the immune response), and recovered. One year later, he appeared well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Kawasaki disease, Kawasaki syndrome, Meissner, H.Cody, Pasternak, Mark S.

---

Similar abstracts:

• Abstracts: A 25-year-old Haitian man with chills, fever, abdominal pain, and renal failure
• Abstracts: A 58-year-old man with hematochezia and a lesion of the cecum. A 33-year-old woman with exertional dyspnea and Raynaud's phenomena
• Abstracts: A 53-year-old woman with cutaneous thickening and eosinophilia. A 74-year-old woman with subxiphoid pain and narrowing of the esophagus
• Abstracts: A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States. Early progression of disease in HIV-infected infants with thymus dysfunction

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.