19214295 Visualization

A 71 Age - year Age - old Age woman Sex with known diastolic Detailed_description congestive Disease_disorder heart Disease_disorder failure Disease_disorder (CHF) Disease_disorder presented to the ER Nonbiological_location with exacerbation Detailed_description of CHF Disease_disorder and a decreased Lab_value level Sign_symptom of Sign_symptom consciousness Sign_symptom .
Brachial Biological_structure blood Sign_symptom pressure Sign_symptom (BP) Sign_symptom was measured at 55/40 Lab_value mmHg Lab_value .
The patient had four History recent Detailed_description admissions Clinical_event with History exacerbation Detailed_description of History CHF Disease_disorder .
Her medical History history History was History also History significant History for History autoimmune Detailed_description hepatitis Disease_disorder , but History preserved Detailed_description liver Diagnostic_procedure function Diagnostic_procedure ; esophageal Biological_structure varices Biological_structure with History a History bleeding Detailed_description episode Detailed_description ; and long Detailed_description - term Detailed_description corticosteroid History therapy History complicated History by History adrenal Disease_disorder insufficiency Disease_disorder , type Disease_disorder 2 Disease_disorder diabetes Disease_disorder mellitus Disease_disorder and History osteoporosis Disease_disorder .
Recent echocardiography Diagnostic_procedure had revealed moderate Severity concentric Detailed_description left Biological_structure ventricular Biological_structure hypertrophy Disease_disorder with diastolic Detailed_description dysfunction Detailed_description , and mild Severity to moderate Severity mitral Disease_disorder regurgitation Disease_disorder .
Cardiac Diagnostic_procedure catheterization Diagnostic_procedure in a recent admission Clinical_event demonstrated 50% Lab_value stenosis Disease_disorder in the second Biological_structure diagonal Biological_structure artery Biological_structure , with mild Severity diffuse Detailed_description disease Coreference in the other Biological_structure coronary Biological_structure arteries Biological_structure .
Right Detailed_description ventricular Detailed_description endomyocardial Detailed_description biopsy Diagnostic_procedure had ruled out myocarditis Disease_disorder and infiltrative Detailed_description cardiomyopathies Disease_disorder , but healing Detailed_description ischemic Disease_disorder microinfarcts Disease_disorder with atheroemboli Disease_disorder were observed.
Previous BP Diagnostic_procedure values Diagnostic_procedure were also low Lab_value ; systolic Diagnostic_procedure BP Diagnostic_procedure was between 60 Lab_value mmHg Lab_value and 65 Lab_value mmHg Lab_value , and diastolic Diagnostic_procedure BP Diagnostic_procedure was between 40 Lab_value mmHg Lab_value and 45 Lab_value mmHg Lab_value .
Following intubation Therapeutic_procedure , dopamine Medication was started for hypotension Therapeutic_procedure management Therapeutic_procedure and was later replaced Clinical_event with noradrenaline Medication .
The patient developed atrial Disease_disorder flutter Disease_disorder but successfully converted Clinical_event to sinus Sign_symptom rhythm Sign_symptom with two Lab_value direct Detailed_description current Detailed_description electric Therapeutic_procedure shocks Therapeutic_procedure .
Cardiology Diagnostic_procedure consultation Diagnostic_procedure resulted in admission Clinical_event to the coronary Nonbiological_location care Nonbiological_location unit Nonbiological_location (CCU) Nonbiological_location .
On admission Coreference to the CCU Biological_structure , BP Diagnostic_procedure was measured at 56/36 Lab_value mmHg Lab_value in the left Biological_structure arm Biological_structure but was not Lab_value detectable Lab_value in the right Biological_structure arm Biological_structure .
An arterial Diagnostic_procedure line Diagnostic_procedure was inserted via the femoral Biological_structure artery Biological_structure , and BP Diagnostic_procedure was measured at 191/92 Lab_value mmHg Lab_value .
BP Diagnostic_procedure values Diagnostic_procedure were consistently Detailed_description much Severity higher Lab_value through Detailed_description the Detailed_description femoral Coreference arterial Coreference line Coreference than Detailed_description the Detailed_description cuff Coreference on Detailed_description the Coreference arms Coreference , and was higher Lab_value in Detailed_description the Detailed_description left Biological_structure arm Biological_structure than Detailed_description in Detailed_description the Detailed_description right Biological_structure arm Biological_structure .
For instance, on Date the Date first Date day Date post Date - CCU Date admission Date , BP Diagnostic_procedure at Time one Time point Time was measured at 170/80 Lab_value mmHg Lab_value through the arterial Coreference line Coreference , while cuff Coreference readings Coreference on the Coreference arms Coreference were 83/74 Lab_value mmHg Lab_value on the left Biological_structure and 60/39 Lab_value mmHg Lab_value on the right Biological_structure arm Biological_structure .
To investigate the inconsistency between brachial Biological_structure and femoral Biological_structure BP Diagnostic_procedure values Diagnostic_procedure , a computed Diagnostic_procedure tomography Diagnostic_procedure (CT) Diagnostic_procedure scan Diagnostic_procedure of the thorax Biological_structure was obtained using 1.25 Distance mm Distance slices Diagnostic_procedure , both before and after intravenous Administration contrast Diagnostic_procedure injection Diagnostic_procedure with sagittal Detailed_description and Detailed_description coronal Detailed_description planar Detailed_description reformatting Detailed_description of maximum Diagnostic_procedure - intensity Diagnostic_procedure projection Diagnostic_procedure images Diagnostic_procedure .
Analysis of the initial Detailed_description unenhanced Detailed_description CT Coreference images Coreference showed densely Severity calcified Detailed_description plaque Sign_symptom or thrombus Sign_symptom at the origins Biological_structure of Biological_structure both subclavian Biological_structure arteries Biological_structure and the right Biological_structure common Biological_structure carotid Biological_structure artery Biological_structure .
The CT Diagnostic_procedure angiogram Diagnostic_procedure showed absence of flow Sign_symptom in the right Coreference subclavian Coreference artery Coreference , a very Severity tight Detailed_description stenosis Disease_disorder at the origin Coreference of Coreference the Coreference left Coreference subclavian Coreference artery Coreference and a tight Detailed_description stenosis Disease_disorder at the origin Coreference of Coreference the Coreference right Coreference common Coreference carotid Coreference artery Coreference .
Both Coreference vertebral Coreference arteries Coreference showed normal Lab_value calibre Sign_symptom and flow Sign_symptom (Figure 1).
Further Therapeutic_procedure management Therapeutic_procedure following the insertion of the femoral Diagnostic_procedure arterial Diagnostic_procedure line Diagnostic_procedure was based on femoral Detailed_description BP Diagnostic_procedure readings Diagnostic_procedure with diuretics Medication and BP Medication - lowering Medication agents Medication .
The patient was eventually discharged Clinical_event in stable Lab_value condition Diagnostic_procedure .
She remained Clinical_event stable Clinical_event during Duration the Duration eight Duration months Duration between Duration discharge Date and Duration the Duration time Date the Date present Date report Date was Date written Date , without further Detailed_description exacerbation Detailed_description of CHF Disease_disorder or related ER Clinical_event visits Clinical_event .