Cardiovascular System Case Study The Complaining Postal Carrier Tony is a 59 year old rural postal worker who goes to se

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Cardiovascular System Case Study The Complaining Postal Carrier Tony is a 59 year old rural postal worker who goes to se

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Cardiovascular System Case Study The Complaining Postal Carrier Tony Is A 59 Year Old Rural Postal Worker Who Goes To Se 1
Cardiovascular System Case Study The Complaining Postal Carrier Tony Is A 59 Year Old Rural Postal Worker Who Goes To Se 1 (81.45 KiB) Viewed 19 times
Cardiovascular System Case Study The Complaining Postal Carrier Tony is a 59 year old rural postal worker who goes to see his family physician for an examination. Tony complains that he has been experiencing brief and unpredictable dizzy spells for the past 2- 3 years. In addition to these symptoms, Tony has recently noticed occasional pain and numbness in his left arm. Exercise increases both the intensity of the pain and the duration of the numbness. Tony tells the physician that he made the appointment at the urging of his wife. Initial Examination: The physician notes the following during his examination and discussion with Tony: 1. In addition to dizziness, symptoms include nausea, occasional fainting spells, and blurred vision. 2. The duration of these spells varies, ranging from a few seconds to several minutes. 3. The patient is robust and exercises regularly, playing tennis once or twice a week and running 20-25 miles per week at an 8-minute mile pace. 4. The patient reports that he carries his postal bag on his left shoulder 99 percent of the time.
5. Blood pressure is 180/95. 6. Pulse is 55/minute and strong 7. The patient's family has a history of atherosclerosis. The physician suspects that the pain and numbness in Tony's arm could be caused by the long- term effects of carrying the heavy postal bag on the same shoulder. He instructs Tony to carry the mailbag only on his right shoulder for 7 to 10 days. At the end of this time period Tony is to carry the bag by alternating shoulders, switching every 10-15 minutes, for an additional 7 to 10 days. Noting the elevated blood pressure, the physician prescribes a medication for hypertension. Tony is scheduled for a follow-up examination Follow-up Examination: At the follow-up examination, Tony states that he has been carrying his postal bag as instructed. However, the symptoms have persisted and in some instances intensified. The physician now has time for a more extensive examination and finds that: the duration of the spells is increasing, with the average spell now lasting 4–6 minutes the frequency of the spells has also increased, to every other day the occasional pain and numbness in the left arm have increased in intensity and duration; exercise seems to intensify the symptoms, e.g., within the past week, the pain and numbness were such that Tony was not able to play tennis or run • blood pressure, as measured in the right arm, is 180/95 blood pressure, as measured in the left arm, is 93/70 pulse, as measured at the right wrist, is 55/minute and strong pulse, as measured at the left wrist, is 55/minute but diminished in strength bilateral carotid pulses are strong and symmetrical there is diminished pulsation in the left supraclavicular fossa, accompanied by a systolic bruit when asked to hold a light weight in his left hand and repeatedly lift it over his head, Tony complains of numbness and tingling in the arm, accompanied by lightheadedness and dizziness . no such symptoms accompany the identical exercise when the weight is held in his right hand Discussion: A physician must piece together the various clues that lead to a correct diagnosis. The patient's symptoms, any physical signs, and the physician's interpretation are part of the detective work. To consider the meaning of the information presented in the case above, you need to review the anatomical material covered in Chapters 20 through 22. The questions below will guide you in your review. Try to answer each one, referring back to the appropriate chapters if you need help.
1. Tony is experiencing dizziness, nausea, occasional fainting spells, and blurred vision. Which system of the body is likely implicated by these symptoms? 2. What is the vascular supply to the system that would be responsible for Tony's dizziness, nausea, occasional fainting spells, and blurred vision? 3. The physician noted a diminished strength in Tony's pulse at the left wrist. Is there a difference in the distribution of blood vessels serving the right and left wrists? If so, what is the anatomical difference? 4. How does the finding of a diminished pulsation in the left supraclavicular fossa relate to this anatomical difference? 5. Tony's bilateral carotid pulses are strong and symmetrical. What is the significance of this finding? 6. Have you had any experience with a patient with similar anatomy? If so, what was the result? If you do not have experience with a similar patient with this anatomy, what do you think might occur when caring for this type of patient?
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