 | Case 1. A middle-aged woman with chest pain and classic mitral
valve prolapse. Critical clinical, EKG and x-ray findings are coupled to
the verification of MVP using ultrasound. Exclusion of coronary disease
is achieved non invasively by exercise echo. "Time-Outs" emphasize
the economics of her workup, the pathophysiology of mitral valve prolapse
and the historical background of this recently-discovered disease.
|
 | Case 2. A female university student with an innocent systolic
murmur. The diagnosis is made largely on clinical grounds and confirmed
by ultrasound. The high prevalence of this finding in adolescents, young
adults and athletes is emphasized. "Time-Outs" review normal cardiovascular
physiology, the economics of evaluating this problem, and the historical
roots of the Hippocratic dictum of "Do no harm." |
 | Case 3. A 23 year old pregnant woman with a systolic murmur.
She turns out to have a congenital bicuspid aortic valve. The diagnosis
is suspected clinically and verified by echocardiography. Her findings are
compared with Case 1 (the first of many comparisons). The question of congenital
heart disease in the adult is reviewed briefly by Dr. Amnon Rosenthal, a
nationally recognized authority. "Time-Outs" stress the physiologic
changes of pregnancy and the discovery of the stethoscope as the first major
milestone in the development of diagnostic cardiovascular technology. |
 | Case 4. A 63 year old office worker who develops pulmonary edema
due to acute mitral regurgitation. Pulmonary causes for his problem are
all but eliminated in the emergency room by expert pulmonologist Dr. Robert
Green. Nine hours after onset of his symptoms the diagnosis is confirmed
by transesophageal echocardiography and the patient is in the operating
room. Special consultations are obtained from Sherlock Holmes in this case
and "Time-Outs" review Dr. Arthur Conan Doyle's medical background
and the similarities between diagnosis and detection. |
| Case 5. A 64 year old man with rheumatic valvular disease (aortic
and mitral regurgitation) develops diabetes and coronary artery disease
later in life. He has successful double valve and bypass surgery and is
re-evaluated postoperatively. |
| Care 6. A 60 year old man with classic coronary artery disease
complicated by myocardial infarction, ventricular arrhythmias, and congestive
heart failure. Despite his disease he has remained active and productive
for 35 years. |
