Studying the classics

Article Abstract:

A 25-year-old woman who was 27 weeks pregnant had a cough with blood, shortness of breath, vomiting, and a history of tuberculosis. Blood tests and an x-ray showed anemia, abnormal blood pressure, enlarged blood vessels in the chest. These symptoms suggest mitral stenosis and heart failure, although her physicians did not hear a heart murmur suggestive of these problems upon initial examination. As a result, the patient's treatment focused on antibiotic therapy for the apparent lung infection. The presence of pink fluid in her wind pipe and an electrocardiogram further suggested mitral stenosis, which was finally confirmed by an echocardiogram. The woman delivered a healthy baby, and underwent a successful procedure to widen her mitral valve. Her physicians initially overlooked mitral stenosis, probably because lung infections are more common and it is difficult to hear a heart murmur in a patient with loud breathing sounds and an accelerated heart beat. Mitral stenosis primarily occurs in women several years after rheumatic fever when the heart is put under stress, as it is in pregnancy.

Mitral valve stenosis

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Rare x rare

Article Abstract:

A 70-year-old man was diagnosed with amyloidosis. Amyloidosis is a disease characterized by protein deposits in different organs and tissues of the body. The patient consulted a cardiologist complaining of chest pain and shortness of breath. He had begun experiencing chest pain and shortness of breath during exercise four years before the consultation, and had been diagnosed with microvascular angina (syndrome X). He had been treated with calcium-channel blockers and beta-blockers. He had also experienced numbness in his fingers, which had been diagnosed as carpal tunnel syndrome. He was admitted to the hospital with severe shortness of breath and heart failure. A biopsy of heart muscle revealed that he was suffering from amyloidosis of the heart and lungs, a disorder with no treatment. His symptoms grew progressively worse during the year following his diagnosis, and he died of cardiac arrest.

Amyloidosis

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Bedside rounds revisited

Article Abstract:

Physicians should consider presenting patients' cases at the bedside. This practice was common 50 years ago, but now most physicians discuss patients' cases in a conference room. This has probably happened because physicians are busier and can better review X-rays in a conference room. However, a 1997 study found that patients were more likely to have a positive view of their hospital experience if the physicians made bedside rounds. This allows patients to participate in their health care.

Social aspects, Care and treatment, Editorial, Physician and patient, Physician-patient relations, Hospital patients

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