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Fatal Pulmonary Hypertension And Rheumatoid Vasculitis

Posted Aug 05 2010 12:00am

Here is a case study report in pdf format that focuses on a subject who is a 51 year old non-smoker, with a history of  mild asthma presented with an 8 month history of deteriorating exercise tolerance.

Below is a small portion of the report…

He was no longer able to cycle more than
a few hundred metres, was dyspnoeic on climbing stairs,
and had been forced to give up his job as a postman.
Rheumatoid arthritis, affecting principally the right knee,
had been diagnosed on the basis of a synovial biopsy
and a positive rheumatoid factor 15 yrs previously. He
took paracetamol occasionally for the knee pain, but was
on no medication apart from inhaled salbutamol and
Examination revealed central cyanosis, no clubbing,
and a few crackles at both lung bases. There was a parasternal
heave but normal heart sounds, no increase in
venous pressure and blood pressure was 140/86 mmHg.
There was minimal evidence of rheumatoid arthritis, apart
from slight restriction of movement in the right knee.
Serial chest X-rays showed an increase in the size of
the cardiac silhouette and pulmonary arteries over a 5
year period, but no evidence of interstitial lung disease.
Electrocardiography (ECG) showed evidence of pulmonary
hypertension with “P” pulmonale and evidence of right
ventricular hypertrophy. ECG showed reasonable left
ventricular function but paradoxical septal movement.
The right atrium and ventricle were markedly dilated,
but there was little sign of ventricular hypertrophy and
no intracardiac shunt. Doppler measurements of the right
ventricular systolic pressure were not performed. Perfusion
lung scanning showed no evidence of thromboembolic
disease. Computerized tomographic scanning of the thorax
was normal with no evidence of emphysema, pleural,
or interstitial lung disease.
Lung function tests showed mild airflow obstruction
with forced expiratory volume in one second (FEV1)
2.9 l·s-1 (81% predicted), forced vital capacity (FVC) 4.6
l (98% pred), and FEV1/FVC ratio 66%. There was
evidence of hyperinflation and gas-trapping, with a total
lung capacity (TLC) 120% pred, and residual volume
(RV) 154% pred. Corrected gas transfer coefficient (KCO)
was grossly impaired at 13% pred. A flow-volume loop
suggested small airways disease, with forced mid-expiratory
flow (FEF25–75) only 28% pred. Arterial blood
gases breathing room air showed pH 7.45, arterial oxygen
tension (PaO2) 8.4 kPa, arterial carbon dioxide tension
(PaCO2) 3.2 kPa, and base excess 4.2 mmol·l-1. Sleep
studies excluded any form of sleep-disordered breathing.
Rheumatoid factor was positive in a titre of 1:640. Full
blood count was normal with an erythrocyte sedimentation
rate of 20 mm in the first hour.

Well, the one thing that I immediately identified with in this report was the subject himself, as I am only two years older then he is right now, and I already have issues with my breathing capacity ( I try not to think too much about just how badly I am hurting myself by continuing to work at the fragrance factory that I work at now ) plus my issues with walking up and down the stairs of the factory all day long…and I won’t even mention the neuropathy issue that makes this activity all the better!

To read the full report please just click the link below

Fatal pulmonary hypertension and rheumatoid vasculitis

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