Online
Clinical Case Study (October
2006)
Clinical
Cardiology Series
臨床心臟科個案研究
The
content of the Office Cardiology Series is provided by:
Dr. LI Siu Lung, Steven
F.H.K.A.M. (Med), F.R.C.P. (Glasg), F.R.C.P. (Edin), F.R.C.P.
(Lond), Specialist in
Cardiology
Dr. WONG Shou Pang, Alexander
F.R.C.P., F.H.K.A.M.(Med.), F.H.K.C.P., Specialist in Cardiology
臨床心臟科個案研究之內容誠蒙李少隆醫生及王壽鵬醫生提
供。
A 43 year old man
was admitted because of sudden palpitation. He enjoyed good past health and
has no known coronary risk factors. His blood pressure was 108/56 mmHg.
Answers
| 1. |
His
ECG was as followed.
What are your differential diagnoses?
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The ECG showed
narrow complexes tachycardia at a rate of 173bpm with some ventricular
premature beats. The differential diagnoses include atrial flutter and
atrioventricular nodal re-entry tachycardia.
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| 2. |
ATP
20mg was given IVI as a bolus. This was his ECG strip afterwards. What
is your diagnosis?
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Underlying
flutter waves were seen after the AV block induced by ATP. The diagnosis
was atrial flutter.
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| 3. |
His
arrhythmia soon recurred and his blood pressure was now 95/48 mmHg and he
complained of some dizziness and chest discomfort. What will you do? |
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In case of
hemodynamic instability, DC version is indicated. Atrial flutter usually
responds to DC version well and energy as low as 50J may suffice. This
was his ECG strip after 50J DC version.
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| 4. |
What
treatment options would be available to prevent future recurrence? |
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Drugs like
class III or Ia drugs may prevent further recurrences but they are of
considerable side effects and long term maintenance is needed.
Radiofrequency
ablation of atrial flutter, on the other hand, achieves a high success
rate with a potentially curative effect.
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Dermatology
Series 皮膚科病例研究
A 56 year old woman
noticed multiple asymptomatic whitish spots on her lower limbs for one year.
The spots were asymptomatic and they increased in number gradually. There was
no history of trauma. Her past health was unremarkable. Physical examination
showed multiple well-defined depigmented macules, measuring < 5 mm in diameter.
Both lower limbs were affected symmetrically and there were also some lesions
on her forearms. She worried about vitiligo.
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The
content of the Dermatology Series is provided by:
Dr. CHAN Loi Yuen, Dr. KU Lap Shing, Simon & Dr. TANG Yuk Ming,
William
Specialist in Dermatology & Venereology
皮膚科病例研究之內容誠蒙陳來源醫生、顧立誠醫生及鄧旭明醫生提供。 |
Answers
| 1. |
What
is the clinical diagnosis?
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The clinical
diagnosis is idiopathic guttate hypomelanosis. It is an acquired, benign
leukoderma consisting of multiple 2 to 5 mm size white spots found on
the shins and forearms. It is a very common condition. It is more common
in women and begins around the age of 30 years.
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| 2. |
What
are the differential diagnoses?
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The differential
diagnoses are vitiligo, pityriasis versicolor, post-traumatic hypomelanosis
and lichen planus.
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| 3. |
Did
she have vitiligo?
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The followings
are against the diagnosis of vitiligo: multiple, small lesions of uniform
size, and the lesions remain static in size.
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| 4. |
What
is the cause of this dermatosis?
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Skin biopsy
demonstrates there is absence of melanin and reduction in number of melanocytes
in the lesional area. It is thought to be an inevitable part of ageing
process with gradual reduction in melanocyes, a similar process to graying
of hair. Sun damage to melanocyte also plays a role.
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| 5. |
What
is the treatment?
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Protection
against sunlight is very important. Treatment is not required as the condition
is harmless. Topical steroids, topical tretinoin and cryotherapy have
been reported to improve the appearance.
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