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POLYVINYL.CHLORIDE STUDY
Reason for consultation: 44 year old white male exposed to polyvinyl chloride.
PRESENT ILLNESS:
, 44 year old male, with B.F. Goodrich for 22 years, has been exposed to polyvinyl chloride, "minimal amount". By way of cardiovascular assessment the patient claims to be totally asymptomatic, denies specifically hypertension, diabetes, heart enlargement, cholesterol or triglyceride ab normalities. No shortness of breath, dyspnea, PND, orthopnea, edema, cyanosis, rheumatic heart disease, scarlet fever and no chest symptoms, palpitations, or chest pressure.
Personal history includes the smoking of cigarettes from the age of 16 to the age of 41. He stopped following that. Alcohol includes three beer/week; wine rare; whiskey once/month. Medications include Allopurinol 100 mg/day. Family history is negative for hypertension, diabetes, heart disease, and other dread diseases. Head, eyes, ears, nose and throat includes partial dentures and wearing of glasses. Respiratory negative. GI negative, GU negative, neuromuscular negative.
Cardiac physical examination: Blood pressure was 100/85, rate 70 lying; 110/85, rate 85 standing. Respirations 15. Head, eyes, ears, nose and throat were unremarkable. Negative funduscopic exam. Neck examination was within normal limits. The chest was clear to percussion and auscul tation.
Cardiac exam revealed the PMI at the left midclavicular line, fifth inter space. The first and second heart sounds were normal, but no third or fourth heart sound, no murmur, rub or click. Abdominal exam was normal with no organomegaly. Neuromuscular exam was normal. Pulses were 2+ and equal in four extremities. The cardiovascular graphics included the following: Electrocardiogram revealed sinus bradycardia at a rate of 55. Holter shows areas of sinus tachycardiac, sinus arrhythmia, 2 PVC's/24 hours. The chest x-ray was normal. The phonocardiogram was normal. Graded exercise test was non-diagnostic maximal test because of the non-specific ST abnormalities occurring 5 and 8 minutes after exercise. Echocardiogram showed prolapse of the posterior mitral valve.
Discussion and Assessment:
This patient is totally asymptomatic with a long history of smoking. His abnormalities were demonstrated on the graphics including some premature beats, some non-specific ST changes on exercise test and evidence of Barlow's with posterior mitral valve prolapse on echo.
ETI0L0GIC DIAGNOSIS: 1) Exposure to toxic agent, polyvinyl chloride. ANATOMIC DIAGNOSIS: 1) Possible arteriosclerosis of the coronary arteries
because of some ST abnormalities on the graded ex ercise test although not diagnostic. PHYSIOLOGIC DIAGNOSIS: 1) Sinus rhythm, occasional premature atrial.occasional
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BFG66497
function with prolapse of the mitral valve. CARDIAC STATUS: Probably unknown, but not compromised. PROGNOSIS: Good.
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BFG66498
Number Age; ^
UNIVERSITY OF LOUISVILLE
REOACTE
Cardiac Function Laboratory
Treadmill Exercise Tolerance Test-Modified Bruce
Name: (last, first, middle initial)
Date of lest
Sex: 'Mm
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3
17
Diagnosis; Routine
Medications; Alpernaul
Protocol:Three minutes walking at each indicated level with blood pressure, heart rate and ventilation as recorded.
77
Speed Grade Heart Heart mph % Pressure Rate
CONTROL (Supine)
100/85 69
CONTROL (Standing)
1 II III IV V VI VII VIII
1.0 1.7 2.5 3.4 4.2 5.0 5.5 6.0
5 10 10 14 16 18 20 22
110/85
140/80 180/80 150/80 140/80 160/85
85
91 108 114 136 158
Predicted 85% Rate: Maximal Heart Rate: 180
Submaximal Heart Rate: 153
*
Immediately after ^37 140/80
Blood Pressure and Pulse Recovery (Supine)'
2 minutes after ^5
5 minutes after
150/70
130/70
8 minutes after 105 110/60
Patient Attained Cutoff Point of;
HR 180,
HR 200,
Syst. BP 240,
Diast. BP 140
Significant fall in Blood Pressure, subjective distress, other,
at the end of
2` 50"
minutes of Stage VI______
.
Treadmill duration score (TPS) __________ 17 minutes. 00"
_________________________
remarksI
Baseline - Normal Monitor - Normal Immed. no ST decrease
2, no ST depression 5-8 nonspecific ST abnormality 5/8" post.
Impression: Maximal Test Nondiagnostic because of NAST/T not clearly'ischemic
BFG66499
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SECTION OF CARDIOLOGY
UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE r----- l;-- i ------*.--,
upl I WJ ywUwi W w /
NAME DATE 3-17-77
AGE: i/t
MEPS.
HOSP. LOC. __________________ CLINICAL DX.
HOSP. NO. NYHA CLASS REF. PHYS.
Interpretations; (ACG, PCG, JVP# CPT) PCG - ?
Impression:
Intervals
Normal Range
Patient
Heart Rate 60-100/m.
84
PR 0.12-0.20 sec.
.16
Aj P2 0.01-0.04
,Q4
<0.06
a2 os J"v"e> z >0.09 (mild)
Q-l 0.03-0.07
.03
A2-*S3 0.10-0.20
___
Ejection Ti me 0.28-0.34
. 26
U. Time 0.05-0.11 t Tim. 0.02-0.04
, 05
BFG66500
Section of Cardiology, Department of Medicine University of Louisville School of Medicine Louisville General Hospital
ECHOCARDIOGRAPHIC STUDY
Name _______________________ ________________ Age 44 Sex M Room *
Hasp, *
Diagnosis:
Ht. Wt. B. S. A.
Referred by Dr.
Date
NORMAL RANGE
TEST RESULTS
RVD______________________________ 0.7 -2.4
RVD INDEX
0.3 -1.1
LVID______________________________ 3.7 -5.4 LVID/M2__________;_______________ 2.27-3.03
Posterior wall thickness Septal wall thickness
LAID
Aortic outflow
-
Aortic valve dimension Pericardial effusion?
Mitral valve velocity D.C. R.
Mitral valve excursion
0.8 -1.1
0.7 - 1.2
1.9 -3.8
2.0 -3.7
1.6 -2.6
80 mm/sec. 150 mm/sec. over 20 mm
or 2.0 cm
COMMENTS:
..
1) Data insufficient to interpret
2) Consistent recording of mitral valve prolapse
INTERPRETATION:
BFG66501
HOLTER MONIIOR CARDIOVASCULAR GRAPHICS LABORATORY
UNIVERSITY OF LOUISVILLE
NAME_________ REFERRED BY__
B. F. Goodrich
MEDICATIONS Alpernaul
INTERPRETATION:
Rote
HOSP. NO. DIAGNOSIS
DATE 3/17-18/77 Routine
Rhythm
ST
T
Sinus tachycardia Sinus arrhythmia Two Premature Ventricular Contractions
REDACTED
(BASELINE ECG)
ECG FORMS - LGH
NAME:
ECG NO.:-
AGE: 44
HOSP. NO.:
WARD OR CLINIC:
DATE: 3/17/77
Yes No
Yes No
Yes No
Yes No
Medications: Digitalis
-X" Procainamide
A Quinidine
* Beta Blocker
TT
Description:
Rhythm Rate-atrial Rate-vent.
sinus 55 5b
/min. /min.
PR Interval
.7R sec.
QRS Axis
QRS Duration .07
sec.
QT Interval .40 sec.
O
Interpretation:
Sinus bradycardia
Normal
U t P lC A t F O O fiU C II 1V f I 0 0 K ] CO.
BFG66503