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Cases | Cardiothoracic | Kugel

Elsie Kugel: Office visit

Mona pulled Elsie Kugel’s chart and placed it on Dr. Grey's desk with a heads up sticky on the folder saying that she was “coming in as an emergency with trouble breathing and swollen feet.” The last entry in the record was dated 1 month earlier and read as follows:

Elsie Kugel DOB September 20, 1913.
Date: February 1, 2001.
No complaints. Mostly sedentary. Living independently with husband at assisted living complex.
PMHx: Hypertension since age 40; pneumonia age 60, hospitalized for 3 days.
Medications: Nifedipine XL 90 mg QD.
Physical Examination:
Pulse 70 and regular, BP 162/90 both arms, height 54 inches, weight 140 pounds.
Chest: Clear.
Heart: Regular and without murmurs.
Abdomen: Soft and non-tender.
Extremities: No edema.
Assessment: Controlled hypertension.
Plan: Continue medication, return in 6 months for annual examination.

When Elsie arrived 2 hours later Mona took her right back to an exam room, checked her vital signs, and let Dr. Grey know that his patient was ready.

Interview

Dr. Grey: What's the matter Elsie?

Elsie: We just got back from a cruise. The first few days were wonderful. We did everything, ate such rich food. I really overdid it. I’ve been feeling “off” for a few days now.

In the airport I had to sit down every 30 feet because I was out of breath. I just sat there panting, looking at my swollen feet. Max was so worried. I said to him that it was just the Miami heat and that I'd feel better once we were home again in Salt Meadow.

Dr. Grey: Did you feel better?

Elsie: No. My youngest son Rodney picked us up at the airport. He took one look at me, looked at Max’s face, and said he'd take us straight to your office. He called on his cell phone right then. Mona said to come right in, so we did.

Self-assessment question:

Elsie's history suggests that her foot swelling began as a result of deep venous thrombosis.

True
False

The correct answer is False. Swelling in both feet suggest a systemic cause such as renal, cardiac or hepatic insufficiency. Venous thrombosis is a local disorder and usually causes unilateral leg edema.

Next: Physical examination

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Last modified: Thursday, 01-Aug-2002 16:45:18 EDT. (PL)

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