Document MM8VnbDXw3Gx5LM6y3nXJmp2x

POLYVINYL CHLORIDE STUDY Li Reason for Consultation: 49 year old male exposed to polyvinyl chloride. PRESENT CARDIAC ILLNESS: , a 49 year old maintenance foreman with B.F. Goodrich for 9 years has had some possible exposure to polyvinyl chloride although he thinks it is minimal. By way of evaluation of the cardiovascular sys tems: The patient states that he has pericarditis, told it was viral in 1957, and spent 28 days at the Veteran's hospital. At the present time the patient describes a left precordial pain which is hard, dull, its crescendo lasting up to 6 hours. It may come on with rest, exertion, sleep and sometimes after meals but is not specifically related to exertional activity. It can radiate into the left shoulder and the left hand and does so usually with severe episodes or approximately 25% of the time. The patient gets short of breath, has dyaphorasis and palpi tations and sometimes gets dizzy with blurred vision. Each time the patient has an episode he never gets to a physician in time for any acute EKG. He states he has had numerous EKG's in the past. He had been prescribed nitroglycerin but has never taken any. The patient states the episodes used to occur every two to three months but now occur on a weekly basis. The patient notes shortness of breath, marked with exertion and somewhat minimal with less exertion. He has occasional palpitations and occasional nocturnal dyspnea and orthopnea and occasional dependent edema. There is no history for diabetes, hypertension, choles terol or abnormal x-ray. Family history reveals a grandmother and grandfather dying of old age at age 84 and 82. No risk factors for diabetes, hypertension, or heart disease. Personal history includes smoking of 1-2 pack of cigarettes/day since the age of 15. Alcohol consumption includes beer - six/week; occasional so cial whiskey. Weight is stable. Allergies are none. Medications include Ornex for sinus disorder. Operations include tonsil and adenoidectomy, appendectomy and sinus operations. Review of systems includes wearing of glasses and sinusitis for head, eyes, ears, nose and throat. Chest is unremarkable. GI, GU, and neuromuscular negative. Patient claims to have had malaria in 1950, 1952, 1953 and 1954. Apparently told all were stemming from the original infectious episode. Cardiac physical examination: Blood pressure 102/80 standing; 130/80 sit ting; 100/70 lying; pulse 72; respirations 15. Head, eyes, ears, nose and throat negative with no funduscopic abnormalities. Neck examination unremarkable. No venous distention, arterial bruits. Normal carotid upstrokes and no thyroid enlargement. Chest revealed prolonged expira tion with diminished breath sounds bilaterally and occasional wheezes on expiration. No rales heard. Cardiac examination revealed the PMI to be at the left midclavicular line, fifth interspace. First and sec ond heart sounds were normal. A fourth heart sound was auscultated. There was a grade I-II/VI soft systolic ejection type murmur heard at the left sternal border in the standing position only. No diastolic murmurs or other abnormal heart sounds appreciated. Abdominal examina- BFG66458 tiorc unremarkable. No bruits. Extremities - no cyanosis, clubbing nr edema. Pulses were 2+ and equal in all extremities. Cardiac graphics include the following: Electrocardiogram was normal. Holter monitor - episodes of sinus tachycardia. Chest x-ray showed some rude notching of one of the right ribs otherwise normal. Phonocardiogram recorded an intermittent fourth heart sound. Graded exer cise test was normal and submaximal. Echocardiogram was normal. IMPRESSION: Patient gives a history of pericarditis and malaria in the past and gives a current history of suspicious left precordial chest pain somewhat sug gestive of angina although atypical in some features. Patient has been a heavy smoker and cardiac graphics revealed a fourth heart sound recor ded intermittently. It is recommended that this chest pain be further evaluated. FINAL DIAGNOSIS: ETIOLOGIC:1)Exposure to toxic agent, polyvinyl chloride. 2)Possible arterialsclerosis. ANATOMIC: 1) Possible disease of the coronary arteries, arteriosclerosis. PHYSIOLOGIC: Sinus mechanism with sinus tachycardia. BFG66459 Number Age: 4Q UNIVERSITY OF LOUISVILLE Cardiac Function Laboratory Treadmill Exercise Tolerance Test-Modified Bruce Name: (last, first, middle initial) --- Sex: m Ht: 5*6V Wt: 158 AHA Classification Date of Test 2 25 Diagnosis: Routine Medications: None 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) 100/7Q 77 CONTROL (Standing) 1 il 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 22 102/80 97 140/80 140/82 130/75 160/70 175/70 101 120 130 146 164 Predicted 85%: Maximal Heart Rate: 176 Submaximal Heart Rate: 153 .. Immediately after 145/70 2 minutes after 130/70 225 5 minutes after 215 90/100 8 minutes after 110/70 HR 180, HR 200, Significant fall in Blood Pressure, subjective distress, at the end of 11 15" minutes of Stage ll other, Treadmill duration score (TPS) _L_ minutes-___ 15 sec. REMARKS: Control WNL Immed. No ST 4/ REDACTED 2,5,8 No ST Monitor No ST -V BFG66460 Impression: Submax stress test Normal test UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE Graphics Laboratory NAME_ j DATE 2-25-77 aoE: /iq /vicDs. ^inTm ,HOSP. NO. NYHA CLASS REF. PHYS. Interpretations; (ACG, PCG, JVP CPT) HOSP. LOC. CLiNi^-AL DX. JVP - Normal CPT - Normal PCG - S4 . .. internrittantly at LLSB, LLD ACG - not recorded Impression: Intervals Normal Range Patient Heart Rate 60-100/m. __ LUL- PR 0.12-0.20 sec. .16 A2 P2 0.01-0.04 .03 <0.06 A? OS (severe) 2 >0.09 (mild) Q-l 0.03-0.07 A2-S3 0.10-0.20 .05 Ejection Ti me 0.28-0.34 .25 U. Time 0.05-0.11 .08 t Time 0.02-0.04 BFG66461 Section of Cardiology, Department of Medicine University of Louisville School of Medicine Louisville General Hospital ECHOCARDIOGRAPWC STUDY Name Age 49 Sex M Room * Hosp. # Diagnosis: Ht. Wt. B.S.A. Referred by Dr. Date NORMAL RANGE TEST RESULTS RVD RVD INDEX 0.7 -2.4 0.3 -1.1 3.3 (LLD) - LVID LVID/M2 3.7 -5.4 2.27-3.03 4.8 - Posterior wall thickness 0.8 -1.1 0.8 Septal wall thickness LAID Aortic outflow 0.7 -1.2 1.9 -3.8 2.0 -3.7 - 1.0 3.0 3.8 Aortic valve dimension Pericardial effusion? Mitral valve velocity D. C. R. Mitral valve excursion 1.6 -2.6 80 mm/sec. 150 mm/sec. over 20 mm or 2.0 cm 2.0 None 72 2.0 COMMENTS: Nonna! BFG66462