Cardiovascular Disease Case Studies

Mikayla Gress - Angelena Nero - Julie Zalar

Case Study #1

Sarah comes to her pediatrician for her annual check up. She is a sophomore in high school and participates in soccer and softball at her school. Over the past year, she has had a few of unexplained fainting spells, which she attributed to her menstrual cycle. She told her doctor that following her faints, she would lie down and drink some juice or have something high in sugar or iron. She never visited the doctor following the fainting spells as her mother went through the same thing when she was her age. In addition, she explains that she has not been improving this soccer season - she noticed that she trips and falls sometimes and does not have the endurance she once had. She has also noticed an increase in perspiration. She said, "Even when it's chilly in my house at night, I am sweating like it's eighty degrees".

Diagnosis #1

Sarah's pediatrician gives her a usual physical examination. She orders some blood tests to address Sarah's concerns and diagnoses her with non-diabetic hypoglycemia, or low blood sugar not related to diabetes. To treat this, Sarah cannot skip meals and is encouraged to have snacks throughout the day. Because she is not diabetic, her doctor does not want to put her on medication at this time, but after a year or so of monitoring her condition this may change. Her doctor explains that although the goal is to eliminate the fainting spells entirely, they may happen occasionally. Following them, Sarah should eat foods with fast-acting carbohydrates such as: a few pieces of hard candy, a half cup of fruit juice, or one tablespoon of honey. Her doctor also gives her a box of tubes of glucose gel that she can use after a faint if she prefers.

Case Study #2

Jessica is a 27-year-old African American woman who gave birth to her son Jackson seven months ago. He has been a relatively healthy baby, hitting all of his milestones on time, such as rolling over on his belly by himself. However, recently, Jackson has been having inconsolable crying fits up to five times per day. At first Jessica thought he was just colicky, but after adjusting her son's diet accordingly, nothing has changed. She has also noticed that Jackson's hands and feet are swollen a lot of the time and his vision and growth were a good amount below normal at his six month check-up. In addition, Jessica has found that when she checks on Jackson at night during the past week, he has had a fever, which she treated with a baby formula ibuprofen. Despite being a relatively healthy baby up until recently, Jackson is visibly ill and both his mother and his doctor are concerned because any medical problem in such a young child is serious.

Diagnosis #2

Jackson's pediatrician orders blood tests to check on his hemoglobin S. All infants are given this blood test at birth, but it is not uncommon for children and even adults to need to be re-screened later in life. This test came back positive, which called for a series of more blood tests which ultimately found that Jackson has sickle cell anemia. Both Jessica and her husband knew they were carriers of the disease at the beginning of her pregnancy, but decided against an amniocentesis (a test in which amniotic fluid from the womb is taken out with a needle, and tested for a variety of defects) because it offered too much risk for too little benefit. Jessica is told that the only possible cure for her son is through bone marrow transplants. However, both she and the doctor feel that it is too soon in his life to begin such invasive procedures. In the meantime, Jackson was prescribed the antibiotic penicillin, which he may take daily until he is kindergarten-age. He is also given pain-relieving medicines (which, at this time in his life, will only be ibuprofen or acetaminophen, but he will most likely begin taking stronger medications later in life) to take as needed. Finally, Jackson also must take a drug called hydroxyurea, which reduces the frequency of pain, and, over time, may even reduce the need for blood transfusions, which he will need on a regular basis. Jessica is also told that it is of the utmost importance that Jackson gets all of his vaccinations on schedule. Babies with sickle cell anemia are more prone to infections, making vaccinations a necessary part of their lives. Sickle cell anemia is not a death sentence, but if not treated effectively, it can shorten lives.

Sources

Mayo Clinic Staff. "Sickle Cell Anemia." Definition. Mayo Clinic, 11 June 2014. Web. 02 Mar. 2015.


Mayo Clinic Staff. "Hypoglycemia." Mayo Clinic. Mayo Foundation for Medical Education and Research, 20 Jan. 2015. Web.