Question

For each case history provide:

1. a diagnosis;
2. list the criteria required for the diagnosis; and
3. provide examples from the case history for each of the criteria listed.
   For example, if one of the criteria for a diagnosis is "delusions", then you should list "delusions, e.g., believes he is receiving special/hidden messages from television programs that he only understands".

Shorty Rheinbold (Morrison, 1995, p.252-253)

Seated in the clinician's waiting room, Shorty Rheinbold should have been relaxed. The lighting was soft and restful; the sofa on which he was sitting was comfortably upholstered. Angel fish swam lazily in their clean glass tank. But Shorty felt anything but calm. Perhaps it was the receptionist – he wondered whether she was competent to handle an emergency with his sort of problem. She looked something like a badger, holed up behind her word processor. For several minutes he had been feeling worse with every heartbeat.

His heart was the key. When Shorty first sat down, he hadn't even noticed it. It was quietly doing its job inside his chest. But then, without any warning, it had begun to demand his attention. At first it had only skipped a beat or two, but after a minute there had begun a ferocious assault on the inside of his chest wall. Every beat had become a painful, bruising thump that made him clutch at his chest. He tried to do it under his jacket so as not to attract too much attention.

The pounding heart and chest pain could mean only one thing: After two months of attacks every few days, Shorty was beginning to get the message. Then, right on schedule, the shortness of breath began. It seemed to arise from his left chest area, where the heart was doing all its damage. It clawed its way up through his lungs and into his throat, gripping him around the neck so that he could get his breath only in the briefest of gulps.

He was dying! Of course, the cardiologist Shorty had consulted the week before had assured him that his heart was as sound as a brass bell, but this time he was sure it was about to fail. He didn't know why he hadn't died before – he had feared it with almost every attack. Now it seemed impossible that he would survive this attack. He wondered if he even wanted to. That thought made him suddenly feel the need to retch.

Shorty leaned forward so he could grip both his chest and his abdomen as unobtrusively as possible. He could hardly hold anything at all – the familiar tingling and numbness had started up in his fingers, and he could feel his hands shaking as they tried to contain the various miseries that had taken over his body.

He glanced across the room to see whether "Miss Badger" had noticed, but she was still pounding away at her keyboard. No help from that quarter; she hadn't seen a thing. Perhaps all the patients behaved this way. Perhaps –

Answer 1

#. The diagnosis of the patient is Myocardial infarction.

Criteria :-

Detection of an increase or decrease in cardiac biomarker values with at least one value above the 99th percentile of the upper reference limit (URL) and with at least one of the following findings:

Symptoms of ischemia

New or presumed new significant ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB)

Development of pathologic Q waves on the ECG

Imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality

Identification of an intracoronary thrombus by angiography or autopsy