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Washington University Experience | VASCULAR | Infarct - Acute | 4A0 Case 4 History
Case 4 History ---- The patient was a 74 year old woman with a clinical history of diabetes mellitus type II, end stage renal disease (on hemodialysis), coronary artery disease, retinopathy, neuropathy and history of breast and colon cancer. The patient was sent to the ED from her dialysis center on July 2 for decreased heart rate, pallor, weakness, and dyspnea. She was found to have congestive heart failure (volume overload), a non-Q wave MI, and ORSA bacteremia. Within two days of admission, the patient experienced episodes of hypotension. She also was found to have clostridium difficile in the stool, a left atrial thrombus, and hospital acquired pneumonia. The patient's mental status fluctuated with overall decline during her hospital course. On July 25th she became hypotensive, was intubated and sent to the ICU. The patient tolerated hemodialysis poorly from that point on and had declining mental status. Terminally the patient had renal, respiratory and congestive heart failure, and persistent hypotension. On August 17 ventilatory support was withdrawn and the patient expired. ---- At autopsy, the patient had significant hypertensive and diabetic renal disease, acute and remote myocardial infarction. The brain weight was 1080g with Alzheimer disease as well as acute, severe ischemic changes seen in thalamus, midbrain, pons, medulla, and cerebellum.
