Trial Short Case 3 September 2020

Case Summary

34 year old woman

NYHA II dyspnoea

Referred for consideration of surgery

Recent admission with febrile illness and anaemia. Positive blood cultures for Strep Gordinii. Treated with 6 weeks of IV Ben Pen. Echo performed during admission did not show vegetations.

Reports 3 month history of menorrhagia. Seen by gynaecology unit and D&C performed with return of usual menstrual cycle. Histology: endometrial hyperplasia.

Background

Cook Islands Heritage

Obesity: BMI 50

Type II diabetes: HbA1C 7.9%

Rheumatic Heart Disease: Previous bioprosthetic MVR and AVR 5 years ago

Atrial Flutter

1 child

Married

Medications

Metformin 500mg bd

Empagliflozin 10mg morning

Metoprolol 50mg bd

Perindopril 5mg

Warfarin

Examination

145kgs, 165cms

HR 90 regular

BP 145/70

JVP not elevated

Mild peripheral oedema

Chest clear to auscultation

Difficult to auscultate heart sounds. Possible soft systolic and diastolic murmurs.

Slow rising carotid pulsation

Investigations

Bloods: Hb 105, normal renal and liver function

Echo:

Trial Short Case 3 September 2020 Echo.png

Questions:

  1. Outline the medical issues and how you would manage them preoperatively and perioperatively

  2. What procedure would you discuss with her and her family? What risks would you explain? What decisions would you ask them to make preoperatively? What information would you explain to them to guide their decision making?

  3. What are the pressure points her procedure, and what would you do to manage those issues?