Document rB9LL11E8VVnr6Ljn8xKvx84e

POLYVINYL CHLORIDE STUDY (Control) tm Reason for consultation: Participant as a control in the polyvinyl chloride evaluation project. , 36 year old white male manager of industrial relations as B.F. Goodrich for 15 years, gives the following history: He complains occasionally of infrequent left precordial sharp chest pain lasting 5-10 minutes but not related to exertion, meals, not awakening him at night and usually come on at rest. They are not disabling and are not associated with any other cardiac symptoms. The patient specifically denies palpi tations, edema, shortness of breath, dyspnea on exertion, PND, orthopnea. Pains come on quite infrequently for the last one or two years, such as the patient cannot quantitate their average frequency at this time. Pa tient specifically denies rheumatic or scarlet fever, rheumatic heart dis ease, heart enlargement, elevated lipids; no diabetes, no hypertension; the weight is stable. Personal history includes smoking 1^-2 packs/day of cigarettes for 19 years. Alcohol consumption includes 1 beer/week; occasional whiskey average of 2-3/week; medications none; allergies none. Family history reveals a father who has some type of unknown heart dis ability otherwise unremarkable. Past medical history includes an opera tion for hemorrhoids in 1972; a fistular.iri-ario 1973; tonsils and adenoids as a child; and spasm of the bladder occurring at age 16. Physical examination: blood pressure was 104/80; pulse 76; respirations 15. Head, eyes, ears, nose and throat were unremarkable including normal funduscopic examination. Neck examination was normal; no venous distension or arterial bruits; chest clear to percussion and auscultation. Cardiac exam: PMI was at the left midclavicular line, fifth interspace; the first and second heart sounds were normal; there was a palpable, audi ble fourth heart sound; no third heart sound was noted. No murmur, rubs, clicks were appreciated. Abdominal examination was normal; no organomegaly. Extremities were within normal limits; pulses were 3+. Cardiovascular data base included the following: The electrocardiogram was within normal limits; chest x-ray, vectorcardiogram and body surface map will be reviewed at a later date. IMPRESSION AND DISCUSSION: This 36 year old white male has a history of occasional precordial sharp chest pain for 5-10 minutes for the last 1-2 years. He has an excessive smoking history and physical exam reveals and audible palpable fourth heart sound which was recorded on phonocardiogram. DIAGNOSIS: Etiologic: 1) Possible arteriosclerosis. Anatomic: 1) Possible arteriosclerosis of the coronary arteries. Physiologic: 1) Sinus mechanism with sinus rhythm. Cardiac status is unknown at this time and further evaluation is probably indicated. BFG66477 POLYVINYL CHLORIDE STUDY Reason for evaluation: Participant in polyvinyl chloride study. Cardiovascular history: Fifty-five year old white male exposed to polyvinyl chloride. Present Illness: Patient denies any history of orthopnea, dyspnea or orthostatic changes. No pedal edema, palpitations or nocturea, but does complain of dyspnea on exer tion with two flights of stairs and admits to smoking a pack of cigarettes per day for 40 years. The patient has daily sputum production, gives no symptoms related to chest pain, chest pressure, expanding of chest at the present time. Personal history includes smoking of cigarettes, 1 pack/day for 40 years, alcohol consumption includes occasional beer and whiskey. Family history includes no hypertension, diabetes or heart conditions. No lipid abnormalities but a daughter does have high blood pressure. Review of systems is unremarkable including no operations and no current medications. Physical examination: Blood pressure supine 120/80; pulse 75 standing was 150/85 rate 86. Head, eyes, ears, nose and throat examination was unremarkable. Neck examination reveales some slight venous distension, 5 cm above the manubrium. Thyroid was not palpable. Chest revealed bilateral diffused rales and ronchi with occasional expiratory wheezes. Cardiac examination: Revealed the PMI to be most notable in the high epigastric area. First and second heart sounds were unremarkable. There was no third heart sound. There was a positive fourth heart sound auscul tated. No murmurs, rubs or clicks were appreciated. Abdominal examina tion revealed no abdominal megaly, no bruits. Extremities examination revealed no cyanosis, but there was clubbing, no edema present. Clubbings was limited to the upper digits. Pulses were bilaterally intact was grossly intact. The cardiovascular diagnostic procedures performed include the following: The electrocardiogram revealed a terminal conduction delay RSR prominent in lead VI and V2. The graded exercise test was a normal submaximal test with frequent PVC's post exercise and occasionally two in a row. Hoi ter monitor revealed peaked T waves during the recording, but none signifi cant. Chest x-ray revealed blunting of the costal vertebral angles. There was an increase in the left main pulmonary arteries measured 2.7 cm. There was increased enlargement of the ascending aorta and apparently a calcified left node which appeared to be an assicus node. Phonocardiogram revealed an increase in A2 component at the left sternal border, is also recorded at the left lower sternal border to be increased. Echocardiogram revealed enlarge ment of the right atrial cavity. Vectorcardiogram was performed and will be added as an addendum later. BFG66478 REDACTED ASSESSMENT AND DISCUSSION: Rt The patient gives a long history tor cigarette smoxing, sputum pro duction and evidence of possible chronic bronchTtis and chronic obstruc tive lung disease. There are numerous abnormalities in the graphics in cluding evidence for right ventricular cavity enlargement by echo. These aonormalities on x-ray of the chest and including abnormality of the as cending aorta and-a bilateral chest abnormalities, the angles, plus enlargement of the left pulmonary artery, to an abnormal dimension. There was electrocardiographic abnormalities indicating possible right ventricu lar enlargement. The following impressions are made: Etiologic diagnosis: 1) Pulmonary disease - possible corporalanaly. 2) Exposure to toxic agent, polyvinyl chloride. 3) Possible arterial sclerosis. Anatomic diagnosis: 1) Arterial sclerosis of the aorta possible. 2) Dilatation of the aorta root by x-ray. 3) Dilatation of the left pulmonary artery. 4) Enlargement of the right ventricular cavity. 1) Etiologic cardiac diagnosis includes Sinus mechanim, frequent premature ventricular contractions. 2) Intraventricular conduction block. Cardiac status: Guarded. Prognosis: Unknown at the present time. ^(jUihnju^y BFG66479 HOLiER MONITOR CARDIOVASCULAR GRAPHICS LABORATORY UNIVERSITY OF LOUISVILLE . \ n.\`. I HOSP. NO. DATE ..-.-ERRED BY______________________________________ DIAGNOSIS__________________________ iGNS None '."SEPRETATICN: Rate _______Rhythm ST Marked T wave increase suggestive of subepicardial ischemia of unknown cance. BFG66480 ,\ v.T.oer ^5: 55 UNIVERSITY OF LOUISVILLE Cardiac Function Laboratory Treadmill Exercise Tolerance Test-Modified Bruce Name: (last, first, miaaie initial) Sex: M 5'6 3/4"Wt: 136^ -- AHA Classification i: V HUti Pc re or" 2 i4 ! 77 { C ieg nos is Routine .`.^elections: None_______ TrcrocoiiThree minutes walking at each indicated level with blood pressure, heart rate and venrilerien as recorded. . Speed Grade Heart Heart mph % Pressure Rate CONTROL ,Cv.pine) --W 'wWIN /"**> J (Stcnding) 1 i 11 lilIV V VI VII Vili 1.0 1.7 2.5 3.4 4.2 5.0 5.5 6.0 5 10 10 14 16 18 20 22 120/80 150/85 75 86 180/80 180/80 210/90 220/100 235/100 94 104 108 120 150 . Predicted 85%: Maximal Heart Rate: 171 ' Submaximal Heart Rate: 145 immediately arier 245/90 150 Blood Pressure and Pulse Recovery (Supine) 2 minutes after 5 minutes after 150/80 100 8 minures after 36/80 33 oo o 00 o CO Pcrienr Atfainea Cutoff Point of: HR 180, HR 200, Syst. BP 240, Significant fall in Blood Pressure, subjective distress, other, cr the end of 45" nuastes of Stage Treadmill durcrion score (TPS) 15_____ minutes. 4511 ________ Diast. 3? 140 REMARKS: Treadmill discontinued due to marked elevation in systolic pressure and freq-ent ectcpic ventricular contractions. 1. Baseline rSr VI V2 2. Immediately post exdrcise: no ST abnormality, frequent PVC, are sequenri 2,5,8 ' No ST - Frequent PVC are sequential (2) IMPRESSION: Submaximal Test Abnormal Test becaude of PVC BFG66481 (3ASELINE ECG) ECG FORMS - LGH NAME: ECG NO. riOSP. NO.: WARD OR CLINIC: Yes No Yes No Medications: Digitalis XX Procainamide ^ "Quinidine Description: Rhythm Sinus PR Interval _ 15 Rare-atrial 75 /min. QRS Duration .08 Rate-vent. 75 /min. QT Interval .38 AGE: 55 DATE: 2/4/77 Yes No Yc; XX Beta Blocker sec. sec. sec. QRS Axis +50 No XX 0 Interpretation: rSr - VI V2 Ramirez, M.-D. BFG66482 Section of Cardiology, Department of Medicine University of Louisville School of Medicine OJEHLouisville General Hospital ECHOCARDIOGRAPMC STUDY ^ Name Age 55 Sex M Room ^ - Hosp. ^ Diagnosis: Ht. Wt. B. S. A. Referred by Dr. Date 2/4/77 NORMAL RANGE TEST RESULTS RVD RVD INDEX LVID LV1D/M2 0.7 -2.4 0.3 - 1.1 3.7 -5.4 2.27-3.03 4.5 - 3.8 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 1.0 1.2 - 3.0 None 68 1.9 - COMMENTS: Increased Right ventricular cavity. INTERPRETATION: Green/Ramirez * M.O./vcg BFG66483 UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE it" I razor*- N. IvE A.-~C. SC //.EDS. DAic 2-4-// rtCS?. lCC- CLINICAL DX. HOSP. NO. NYHA CLASS REF. PHYS. Interpretations: (ACG, PCG, JVP, CPT) CAROTID PULSE TRACING: Normal PHONGCARDIOGRAM Normal Increased A2 JUGULAR VENOUS PULSE: Normal. APEX CARDIOGRAM ; Not recorded. Impression: Intervals Patienr .82 .15 .08 .29 .15 .04 BFG66484