Case study

Case study
You are to read the following case study and answer the questions as completely as possible without being wordy. You are limited to 2 pages for the assignment. Assignments over 2 pages (not including reference list) will not be graded. Assignments are to be single-spaced and have 1-inch margins. Font should be Arial 12 pt. In-text references are required (minimum 5). Be sure to include each question in bold followed underneath by your response (not bold). AMA style.

Mr. Smith is a white, 56-year-old man seeking medical attention for palpitations. They come on intensely often precipitated by exercise. They generally last about an hour or more causing him to remain inactive until they stop. He has been aware of similar, but less severe events, since high school. He has no other history suggesting heart disease.

Physical exam: White male. Blood pressure 140/92. Pulse: 70 bpm. Respiration: 18/min. Temp: 98.6. Ht: 5 ft 11 in. Wt: 240. Heart murmur indicated.Exercise stress test: Positive: pain reproduced EKG: Indicates left ventricular hypertrophy. An inverted T-wave was also noted.

Cholesterol profile:

· Serum cholesterol 502 mg/dL (normal: <200 mg/dL)

· Triglycerides 198 mg/dL (normal: <150 mg/dL)

· HDL 20 mg/dL (normal: >45 mg/dL)

· LDL 280 mg/dL (normal: 60-180 mg/dL)

Cardiac enzyme levels:

· Creatine phosphokinase (CPK) 20 mcg/L (normal: 10-120 mcg/L)

· Lactate dehydrogenase (LDH) 120 IU/ml (normal: 90-200 IU/ml)

· Serum aspartate aminotransferase (AST) 24 U/ml (normal: 5-40 U/ml)


1. Are all of Mr. Smith’s vital signs normal? What aspects of his physical exam concern you?

2. What does the presence of the heart murmur indicate?

3. Do any of the data suggest a heart attack?

4. If not, what is the most likely diagnosis?

5. What evidence led you to that conclusion?

6. What is left ventricular hypertrophy? What causes it?

7. What does the inverted T-wave indicate? Why does it appear only when Mr. Smith exercises?

8. What do his blood results indicate about his condition?

9. What additional questions might you ask Mr. Smith to better understand his condition?
10. What are your recommendations to Mr. Smith?

* one page is enough

Make it simple English as an international student writing

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