Too old for what?

Article Abstract:

An 87-year old woman with severe shortness of breath was diagnosed with aortic stenosis and coronary artery disease. Aortic stenosis is a narrowing of the aorta. The woman had been healthy and active, had no history of asthma and had never smoked. Shortness of breath among people her age is normally a sign of heart or lung disease. Because she had no history of lung disease, heart failure of the left ventricle and pulmonary embolism were considered the two most likely causes. Her lungs cleared with treatment, but further examination of her heart revealed that she had tight aortic stenosis and serious coronary artery disease that probably contributed to the dysfunction of the left ventricle. Following diagnosis came the difficult decision of whether to recommend surgery for this elderly patient. Would the resources spent and potential complications would be worth the potential improvement in quality of life? The woman did have surgery, and although her recovery was long and difficult, she now has no heart symptoms and is happy she had the operation.

Aged, Elderly, Surgery, Coronary heart disease, Aortic valve stenosis

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Things are seldom what they seem

Article Abstract:

An incorrect diagnosis of alcoholic hepatitis can mask a more serious case of hepatocellular carcinoma, or liver cancer. A 61-year-old man with a history of alcohol abuse, diabetes, high blood pressure, high blood cholesterol and depression went to the hospital complaining of abdominal pain, early satiety and weight loss. He was diagnosed with alcoholic hepatitis based on liver-function abnormalities, an enlarged liver, an increase in white blood cells and alcohol-related depression. His condition improved while in the hospital, supporting this diagnosis. He was released but then readmitted. Further testing revealed a liver tumor. The patient died, and at autopsy his liver was found to be almost entirely replaced with cancerous tissue. In this case, the smoothness of the patient's liver and the patient's apparent recovery were misleading, and high calcium levels, which can indicate a liver tumor, were not evaluated. Given the patient's advanced disease state, an earlier diagnosis would not have changed the outcome.

Liver cancer, Hepatitis, Alcoholic, Alcoholic hepatitis

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Failure to resolve a diagnostic inconsistency

Article Abstract:

A 56-year-old woman died from a massive pulmonary (lungs) blood clot. She was admitted to the hospital with sudden dizziness and left arm pain, after nearly fainting at work. She had a history of hypertension, diabetes, blood clot formation in the veins in her legs and coronary artery disease. She had suffered two heart attacks one and four years earlier. An electrocardiogram (ECG) revealed a rapid heart beat, and a chest x-ray showed clear lungs. Her blood pressure was low. She had low blood levels of oxygen and increased body fluid acidity. She was treated with oxygen, intravenous fluids and a drug to break up blood clots, and was mechanically ventilated. She died from cardiac arrest. An autopsy revealed a massive pulmonary blood clot with an opening in the septum of her heart. A patient with this women's symptoms could be misdiagnosed with a heart attack or aortic dissection. Clear lungs and low levels of blood oxygen were the main indications that she was suffering from a pulmonary blood clot.

Abnormalities, Pulmonary embolism, Heart septum

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