1. Echo- Conference R2 조경민

2. History 10445762 강 O 은 (F/77) Chief Complaint Chief Complaint Chest pain o/s) On the day hospitalization Chest pain o/s) On the day hospitalization Present illness A 77 year old woman had taken medication for variant angina and performed Coronary artery graphy at emergency procedure 12 days ago at KMC medicine. Visited emegency room for chest pain She hospitalized for further evaluation & management

3. Past Medical History Past Medical History HTN (+) :2006 Dx / DM(-) / Hepatitis(-) / Pulmonary TB(-) HTN (+) :2006 Dx / DM(-) / Hepatitis(-) / Pulmonary TB(-) 2006 년 Cerebral infarction 2006 년 Cerebral infarction Operation Hx. (-) Operation Hx. (-) Personal History Personal History Alcohol (-) Alcohol (-) Smoking (-) Smoking (-) Family History Family History Unremarkable Unremarkable History

4. Review of System General Fatigue(-) Febrile sensation(-) Chill(-) Wt. gain (-) Skin Rash(-) Pigmentation(-) Itching(-) H&N Headache(-) Sore throat(-) Respiratory Cough(-) Sputum(-) Hemoptysis(-) Cardiac Chest pain(+) Orthopnea(-) Dyspnea(-) Edema(-) exercise limits (-) Palpitation(-) exercise limits (-) Palpitation(-) G-I Postprandial abd. discomfort (-) Anorexia(-) Nausea(-) Vomiting(-) Abd. pain(-) Vomiting(-) Abd. pain(-) Renal Dysuria(-) Urgency(-) Frequency (-) Hematuria(-) Muscularskeletal pain(-) weakness(-) Characteristics: squeezing Duration: For 1 hour Association symptom: negative Radiation pain :Lt. shoulder area Aggrevating factor: negative Relieving factor: negative

5. Physical Examination V/S 100/60mmHg – 92/min – 20/min - 36°C V/S 100/60mmHg – 92/min – 20/min - 36°C General Appearance General Appearance Alert mental status Alert mental status Acute ill-looking appearance Acute ill-looking appearance Head & Neck Head & Neck No cervical LN enlargement No cervical LN enlargement No neck vein engorgement No neck vein engorgement No thyroid enlargement No thyroid enlargement Eye & ENT Eye & ENT Isocoric pupil with PLR(++/++) Isocoric pupil with PLR(++/++) Pinkish conjunctiva with Clear sclera Pinkish conjunctiva with Clear sclera Body weight :62.2 Kg Height : 164 cm BMI:20.5 kg/m 2

6. Physical Examination Chest Chest Clear breathing sound without crackle or wheezing Clear breathing sound without crackle or wheezing Regular heart beat with out murmur Regular heart beat with out murmur Abdomen Abdomen Soft & flat abdomen Normoactive bowel sound Soft & flat abdomen Normoactive bowel sound Tenderness(-) Rebound tenderness(-) Tenderness(-) Rebound tenderness(-) Back & Ext. Back & Ext. CVA tenderness (-/-) Pretibial pitting edema(-/-) CVA tenderness (-/-) Pretibial pitting edema(-/-) Neurologic examination Neurologic examination Babinski (-/-) Ankle clonus (-/-) Babinski (-/-) Ankle clonus (-/-)

7. Initial Lab. Findings CBC/DC CBC/DC 8480/mm 3 –14.1g/dL – 40.3 % -420000 /mm 3 8480/mm 3 –14.1g/dL – 40.3 % -420000 /mm 3 (Seg. 65%) (Seg. 65%) Chemistry Chemistry Total Bilirubin 1.02mg/dL Total Bilirubin 1.02mg/dL Prot/ Alb 6.7/ 3.9g/dL Prot/ Alb 6.7/ 3.9g/dL AST/ALT 46/ 36 U/L AST/ALT 46/ 36 U/L BUN/ Cr 18/ 0.9 mg/dL BUN/ Cr 18/ 0.9 mg/dL Na/K/Cl 141/4.8/102 mg/dL Na/K/Cl 141/4.8/102 mg/dL Ca/ P /Uric acid 8.6/ 2.5/5.2mg/dL Ca/ P /Uric acid 8.6/ 2.5/5.2mg/dL CK/CK-MB/ Troponin-I : 89/ 15.1 / 0.09 CK/CK-MB/ Troponin-I : 89/ 15.1 / 0.09

8. Chest X-ray (2009.03.24)

9. EKG (2009.03.25)

11. Initial Assessments R/O unstable angina R/O variant angina

12. Echocardiography (2009.03.24) Echocardiography 시행 이유 Echocardiography 시행 이유 : For further evaluation of chest pain : For further evaluation of chest pain

13. Final diagnosis (2009.03.24) Mid ventricular obstruction with SAM & LVH