Case Study and Questions for Clinical Case Presentation
Patrick is a 78-year-old male who has worsening of his left-sided heart failure and COPD.
He is very tired, coughs regularly, and he suffers from dyspnoea. His legs are swollen from the knee down, and he walks slowly.
His current observations and body size measurements are: blood pressure 135/85 mmHg; heart rate 155 bpm, weight 95 kg, height 180 cm, waist circumference 104 cm.
His previous medical history is:
o Smoking from age 20 to approximately 60; he quit smoking in his early 60s. o Myocardial infarction following occlusion of a branch of his left coronary artery, age 68
Patrick’s fasting blood test results include:
Test item Patrick’s value Reference range
Sodium 150 mmol/L 135-145 mmol/L
Potassium 5.2 mmol/L 3.5-5.0 mmol/L
Calcium 2.05 mmol/L 2.15 – 2.60 mmol/L
Haemoglobin 111 g/L 130 g/L
LDL 3.5 mmol/L 2.0 mmol/L
HDL 0.8 mmol/L 1.0 mmol/L
Triglycerides 4.2 mmol/L 2.0 mmol/L
Glucose 8.5 mmol/L 6.1 mmol/L
Q1. Explain the pathophysiology underlying his respiratory symptoms (cough and dyspnoea). (4 marks)
Q2. Identify the cause of his left-sided heart failure failure. Briefly discuss if there is a relationship between his left-sided heart failure and COPD. (2 marks)
Q3. Identify a symptom that suggests he has right-sided heart failure. Explain the causes and pathophysiology underlying his development of right-sided heart failure. (4 marks)
Q4. Identify two factors that could have contributed to his heart rate. (2 marks)
Q5. Explain how his LDL, HDL and triglyceride levels relate to his condition. (3 marks)
Q6. Identify which other organ may be failing as a result of heart failure by explaining his serum sodium, potassium and calcium levels. (5 marks)

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