Student Name Student Number 1. Raymond Pieters 1. 0512308K 2. Jody Rusch 2. 980269 !

Patient"s Name# demo$ra%hic detai& and site o' (isit) *arita +u&e# 62 year o&d ,'rican 'ema&e# married and &i(in$ -ith husband and her sur(i(in$ dau$hter as -e&& as 10 other chi&dren .most&y $randchi&dren/ in 0s1ane. She is a retired domestic -or1er. Sub2ecti(e Presentin$ com%&aint) Since -e &ast sa- *rs +u&e she had under$one a cho&ecystectomy 'or $a&&stone disease. She had been -orried %re(ious&y about the sur$ery and its outcome. 0he ma2ority o' the 'ear in(o&(ed the e''ects o' anaesthetic and -ound hea&in$. ,'ter ta&1in$ to her these 'ears had been 3ue&&ed by her e4%erience. ,'ter the sur$ery she had not e4%erienced any o' her %re(ious concerns and her %ain had im%ro(ed. 5or the %ast month she had 'e&t short o' breathe and had e4ercise into&erance so much so that she had had to abandon her %iece 2obs and remain at home. She &ater sou$ht he&% at the &oca& c&inic 'or this and -as re'erred to 0ambo *emoria& 6os%ita&. She -as unab&e to -a&1 on a '&at sur'ace 'or more than a 'e- metres be'ore becomin$ breath&ess and had ortho%neoa and %aro4ysma& nocturna& dys%noea. ,t 0ambo *emoria& she -as -or1ed u% 'or and treated 'or heart 'ai&ure# -hich she understood as her 7heart not %um%in$ %ro%er&y8 ,'ter bein$ seen at 0ambo *emoria& she -as re'erred to 9har&otte *a4e1e Johannesbur$ ,cademic 6os%ita& -here she is current&y bein$ 'o&&o-ed u%. Past medica& history) ,s %re(ious&y described) :iabetes ty%e ;; <steoarthritis Pe%tic u&cer disease ;n 19=9 -as in(o&(ed in a *>9 in -hich she in2ured her ri$ht hand and needed suturin$ ,&&er$ies) ni& Kno-n *edications) +&ic&a?ide 80m$ and met'ormin 850m$ 'or :*# ,rthro$uard 'orte 'or osteoarthritis# 6ydroch&orothia?ide. S6 She has no- discontinued her use o' snu'' :oes not smo1e or drin1 a&coho& <b2ecti(e +enera& a%%earance) @&der&y %atient not distress -hi&e at rest and sittin$ >ita&s) APB115C=2D 6RB102b%mD RRB18%mD 0em%B 35.=<9 6 E N) 0hyroid norma& 9>S) Pu&ses %resent and e3ua&

 J>P raised at 8cm ,%e4 dis%&aced 6th ;9S &atera& to *9F No %arasterna& hea(e or %a&%ab&e second im%u&se S1S2 norma&# S3 $a&&o% %resent# no murmurs Res%) +,@A# c&ear No e(idence o' %u&monary oedema ,bdo) So't# not distended# cho&ecystectomy scar 2cm tender he%ar Fi(er s%an 12cm Norma& bo-e& sounds *uscu&oBs1e&eta&) Ni& neNeuro) Ni& ne,ssessment) Aio&o$ica&) 6eart 'ai&ure :iabetic ty%e ;; on treatment# -ith %ossib&e %eri%hera& neuro%athy <steoarthritis in ri$ht hand %e%tic u&cer disease Psycho&o$ica&) 9oncerned on 'uture im%&ications o' heart 'ai&ure Socia&) Gnab&e to mana$e 'inancia&&y on %ension $rant as be'ore and concerned 'or 'ami&ies 'uture *ana$ement P&an Presentin$ %rob&em 0reatment 'or heart 'ai&ure 9ounse&&ed on heart 'ai&ure as a condition and im%&ications <n$oin$ %rob&ems and com%&ications 9ontinue diabetes medications and reBem%hasi?ed on im%ortance o' adherence <%%ortunistic hea&th %romotion @m%hasi?ed %re(ious counse&&in$ on diet A&ood %ressure monitored ,c1no-&ed$ed action o' 3uitin$ snu'' and reBem%hasi?ed bene'its P&annin$ 'uture hea&th care 0o be 'o&&o-ed u% at hi$her centre 0it&e o' Port'o&io @ntry) 6eart 'ai&ure and diabetes :iabetes me&&itus increases the ris1 o' de(e&o%in$ heart 'ai&ure in both men and -omen

irres%ecti(e o' other cardio(ascu&ar ris1 'actors .Aa&a and 6ancu# 200 D Kanne& et al., 19= /. 0his ris1 has been sho-n to be doub&e that o' nonBdiabetic ma&e %atients by the 5ramin$ham study -ith re$ard to con$esti(e heart 'ai&ure and in 'ema&es this ris1 has been sho-n to be as hi$h as 5 times more .Kanne& et al., 19= /. 0he ,merican Society o' 9ardio&o$y reco$nises this increased ris1 and has inc&uded it in the ris1 'actors 'or sta$e , c&assi'ication o' heart 'ai&ure .Aa&a and 6ancu# 200 /. 5urthermore u% to =5H o' %atients -ith une4%&ained idio%athic dia&ated cardiomyo%athy -ere 'ound to be diabetic .@ser et al., 2011/. Rub&er 'irst described the condition o' diabetic cardiomyo%athy in 19=2# -hich is characterised by myocardia& dys'unction in the absence o' hy%ertension# coronary artery disease and (a&(u&ar %atho&o$y. 0his condition is associated -ith both diabetes ty%e one and t-o and is hy%othesised to be due to hy%er$&ycaemia# im%aired 'ree 'atty acid metabo&ism# micro(ascu&ar dama$e and im%aired an$io$enesis .@ser et al., 2011/. :ia$nosis o' diabetic cardiomyo%athy is by e4c&usion o' other %atho&o$ies &eadin$ to the de(e&o%ment o' myocardia& dys'unction in the diabetic %atient .@ser et al., 2011/. !ith re$ard to the treatment o' heart 'ai&ure in diabetics# the %harmaco&o$ica& treatment used in nonBdiabetic %atients 'or heart 'ai&ure has a&so been sho-n to be bene'icia& in the treatment o' the condition in these %atients .Aa&a and 6ancu# 200 /. ;n the %re(ention o' diabetic cardiomyo%athy and other causes o' heart 'ai&ure# $&ycaemic contro& is thou$ht to be o' im%ortance as -e&& as reduction o' other cardio(ascu&ar ris1 'actors such as hy%ertension. Fi%id contro& is a&so been sho-n to decrease ris1 o' de(e&o%in$ heart 'ai&ure in diabetic %atients as has the use o' an$iotensin con(ertin$ en?yme inhibitors. .@ser et al., 2011D Aa&a and 6ancu# 200 /. 9onc&usion :urin$ our academic trainin$ at the Gni(ersity o' the !it-atersrand -e ha(e (ery &itt&e o%%ortunity to 'o&&o- u% %atients in the hos%ita& settin$s -e are %rimari&y assi$ned to. :urin$ our indi(idua& rotations -e are unab&e to 'o&&o- u% chronic %atients and as a resu&t &ac1 the sense o' continuity -hich is re3uired 'or chronic %atient mana$ement. 0his assi$nment $a(e some insi$ht into this continuity and a&&o-ed us the rare o%%ortunity to 'o&&o- u% a %atient o(er a year %eriod. 0he %atient -e chose 'or this assi$nment# -ith such a rich medica& history and (ariation o' e(entua& chan$es in direction in her mana$ement a&&o-ed us to understand the condition and it"s 'ar reachin$ e''ects on both the %atient and the hea&th care en(ironment. 5urthermore it a&&o-ed us to (ie- the chronic condition in a betterBrounded manner -ith re$ard to the %atients" understandin$s# 'ears and e4%ectations in terms o' both the condition and its mana$ement. Re'erences 1. Aa&a 9. and 6ancu N. 200 . 6eart 'ai&ure and diabetes. Rom J ;ntern *ed 2.2/) 26=B 2=5. 2. @ser ,.# :i&e1 G.# G&as A.# 0ay'un S. and ;rem I. 2011. :iabetic cardiomyo%athy re(ie-. ,nado&u Kardiyo& :er$ 11)=32B=3=. 3. Kanne& !.# 62ort&and *. and 9aste&&i !. 19= . Ro&e o' diabetes in con$esti(e heart 'ai&ure) 0he 5ramin$ham study. ,merican Journa& o' 9ardio&o$y 3 .1/) 29B3 .