Jornal SBC 161 · Dezembro · 2015
33
Dear readers,
Here follows the dialogue
between the Intern and the
patient’s family doctor.
Physician (patient’s family
doctor –
Hello Dr. Goldman.
How is Mr. Davis doing?
Intern –
He is fine, considering
what he had.
Physician –
What do you
think he had?
Intern –
A myocardial infarction.
Physician –
I have to agree with that. Let’s go to
my room and discuss the problem.
Physician –
What did you find on the physical exam?
Intern –
There really wasn’t anything remarkable.
Physician –
Does that surprise you?
Intern –
No, not really.
Physician –
What conditions would you consider
as ruling out an MI?
Intern –
Pulmonary embolus, cardiac neurosis,
dissecting aneurysm and acute pericarditis.
Physician –
That’s quite good. I would also
consider hiatal hernia. He wasn’t in shock when I
saw him, nor was there any evidence that he was
going into acute pulmonary edema. Would you
expect to see fever at the onset of this condition?
Intern –
Yes, I would.
Physician –
It is usually absent at the onset,
in contrast to acute pericarditis. It will usually
English Corner
rise within 24 hours and remain so for about a
week. Have any of his lab studies come back?
Intern –
Yes, they are over here.
Physician –
Well, his white count is normal.
This will probably go up tomorrow and stay
up for about a week. Would you please order
another one for tomorrow? What would you
expect the sed rate to show?
Intern –
That also goes up on about the second day
and will remain elevated for more than a week.
Physician –
I see his SGOT is elevated, and so
is the LDH. Which one of these will remain
elevated longer?
Intern –
The LDH.
Physician –
Has the cardiogram come up to the
floor with the rest of his chart?
Intern –
Yes, it has. Here it is.
Physician –
There is elevation of the ST‑segment and
T-wave, and these waves look abnormal. His rate and
rhythm appear to be all right. What complications
will you be looking for during his recovery period?
Intern –
Congestive heart failure; pulmonary
embolus, secondary to phlebitis of the leg;
arrhythmias; cerebrovascular accident; rupture
of the heart; and shock.
Physician –
What are the most common
arrhythmias during this period?
Intern –
Ventricular premature beats are the
most common. Atrial fibrillation and prolonged
A-V conduction are next.
Physician –
Well, let us see our patient now.
Best regards, Ricky.
■
Ricky Silveira
Mello
Professor de inglês
especializado em
Cardiologia
rickysilveiramello@
gmail.com
