M
Marge
<<1. Symptoms
''I thought it was my smoking, and so I quit,'' the patient said flatly. His bright blue eyes peered out of his thin, tanned face. ''But, you know, it didn't make any difference.'' He ran his hand through his graying hair. ''I felt like I was going to drop dead just walking to the TV.''
It started a while ago, he told the young resident in the E.R. He would be out of breath when he walked to the store or climbed the stairs. He had to take everything ''real slow.'' Then, a couple of months ago he noticed that his abdomen and legs were swollen -- that's when he went to the emergency room the first time. He was in the hospital for a week and was sent home with diuretics but no answers. He was supposed to follow up with a cardiologist, for further evaluation, but he didn't. He also stopped taking the medicines. He didn't really like doctors. Until this started a couple of years ago, he hadn't been sick since he had rheumatic fever as a child. He came back to the hospital this time only because he was scared and he was too winded to work. ''Hell, I can't even walk.'' >>
The rest of the patient's story is in the May 30 New York Times Sunday Magazine at http://www.nytimes.com/2004/05/30/magazine/30DIAGNOSIS.html
The patient eventually had mitral valve replacement surgery and is now doing fine.
The most interesting thing about this story is that he had two echocardiagrams and a CT scan, but his doctors were unable to determine what his diagnosis was until a third echo finally revealed that he had severe mitral stenosis.
<<How could this happen? How could a test be wrong not once but twice? The cardiologist paused when I asked him this and then said briskly: ''Mistakes happen, but the bottom line was this: Everything pointed to mitral stenosis except for this test. Given that, most likely it was the test that was wrong.''>>
''I thought it was my smoking, and so I quit,'' the patient said flatly. His bright blue eyes peered out of his thin, tanned face. ''But, you know, it didn't make any difference.'' He ran his hand through his graying hair. ''I felt like I was going to drop dead just walking to the TV.''
It started a while ago, he told the young resident in the E.R. He would be out of breath when he walked to the store or climbed the stairs. He had to take everything ''real slow.'' Then, a couple of months ago he noticed that his abdomen and legs were swollen -- that's when he went to the emergency room the first time. He was in the hospital for a week and was sent home with diuretics but no answers. He was supposed to follow up with a cardiologist, for further evaluation, but he didn't. He also stopped taking the medicines. He didn't really like doctors. Until this started a couple of years ago, he hadn't been sick since he had rheumatic fever as a child. He came back to the hospital this time only because he was scared and he was too winded to work. ''Hell, I can't even walk.'' >>
The rest of the patient's story is in the May 30 New York Times Sunday Magazine at http://www.nytimes.com/2004/05/30/magazine/30DIAGNOSIS.html
The patient eventually had mitral valve replacement surgery and is now doing fine.
The most interesting thing about this story is that he had two echocardiagrams and a CT scan, but his doctors were unable to determine what his diagnosis was until a third echo finally revealed that he had severe mitral stenosis.
<<How could this happen? How could a test be wrong not once but twice? The cardiologist paused when I asked him this and then said briskly: ''Mistakes happen, but the bottom line was this: Everything pointed to mitral stenosis except for this test. Given that, most likely it was the test that was wrong.''>>
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