CASE 9

 

PATIENT:  55-year-old woman

 

CHIEF COMPLAINT:  This patient was admitted with of intractable chest pain.  The pain had often been associated with the anxiety that the patient experienced during renal dialysis.

 

MEDICAL HISTORY:  The patient had experienced progressive renal failure over the preceding 3 years.  The exact nature of the renal disease had not been established.  She had been on renal dialysis for approximately 2 years and had arteriovenous fistulas in both arms.

 

FAMILY HISTORY:  There was no history of diabetes mellitus, HTN, or renal disease on the paternal and maternal sides of the family.

 

DRUG HISTORY:  The patient had taken digoxin, Captopril, Natabec (multi-vitamins with minerals), diazepam, cimetidine and nitroglycerin.

 

PHYSICAL EXAMINATION:  Numerous ecchymotic areas were noted over the arms and trunk.  There was no palpable organomegaly.

 

 

LABORATORY RESULTS

 

 

Patient

Normal

 

 

 

Prothrombin time

10.7 seconds

8-11.5 seconds

aPTT

30 seconds

24-37.5 seconds

Platelet count

159,000/μl

150,000-350,000/μl

Bleeding time*

>15 minutes

< 9 minutes

 

*The bleeding time was performed on the right leg due to arteriovenous fistulas in both arms.

 

Hemoglobin level

8 g/dl

12-16 g/dl

Blood urea nitrogen

60 mg/dl

7-18 mg/dl

Creatinine

6.0 mg/dl

0.5-1.1 mg/dl

 

 

HOSPTIAL COURSE:  The patient was found to have severe stenosis in 3 coronary arteries and was prepared for coronary artery bypass procedure.