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Hypertension In The High Seas - Page #3
 

Lab Studies:
None

Other Studies:
The patient's initial 12-lead electrocardiogram demonstrated first-degree atrioventricular block. His coronary calcium score was found to be 193 Angstrom Units, or 78% for his age group. He underwent coronary angiography which resulted in the placement of two drug-eluting stents in his right coronary artery and left anterior descending artery. <br> <br>Though he attempted to return to triathlons after stenting, he experienced a third bout of frank hemoptysis during the swimming event, and his oxygen saturation at the scene was 80%. Hospital admission following this episode included a chest radiograph with evidence of pulmonary edema. Echocardiogram demonstrated severe, concentric left ventricular hypertrophy, mild mitral regurgitation, and mildly abnormal diastolic filling dysfunction. <br> <br>He was not willing to consider abandoning his triathlon aspirations and requested further workup for risk stratification. This included an exercise cardiac catheterization <a href="CaseStudyImages/CS1Hypertensioninthe-981.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a> , which did not demonstrate any evidence of micro-ischemia. Additionally, an underwater stress echocardiogram <a href="CaseStudyImages/CS2CS1Hypertensionin-981.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a> was obtained; the patient's systolic blood pressure rose to 345 mmHg accompanied by a 'gurgling sensation' in his chest.

Consultations:
Cardiology <br>Pulmonology <br>Anesthesiology

Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.

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