Case studies that relate to understanding heart failure in a multicultural society 1

Case studies that relate to understanding heart failure in a multicultural society

1Mary

Mary,30yearsold,wasdiagnosedwithheartfailurelastyear.Shelivesinastate-subsidisedhomeandhashadfourchildren.Afewweeksafterthebirthoftheyoungestone,nowagedthreeyears,sheincreasinglybecameshortofbreathonexertionanddevel-opedorthopnoeaandparoxysmalnocturnaldyspnoea.Atpresentshe

hasgrossoedema,ascitesandapleuraleffusion.Thediagnosisofdilatedcardiomyopathyhasbeenmade.

Zindi Zindi,a15-year-oldgirllivinginan

overcrowdedpartofSowetowithherparents,twoyoungerbrothersandanoldersister,hadanacuteillnesswhenshewassixyearsofage.Shedevel-opedseverefeverandhadamigratingarthritisinvolvinglargerjointssuchasherankles,knees,elbowsandwrists.

Thishadbeenprecededthreeweeksearlierbyasorethroat.Attheageof10years,shebecamefatigued,shortofbreathanddevelopedheartfailure.Shewasdiagnosedashavingchronicrheumaticheartdisease,mitralvalvestenosisandincompetence.

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�� Pocket Guide to Chronic Heart Failure

Rosie Rosie,a72-year-oldobeseladyhas

diabetesandheartfailurewithatrialfibrillation.Shetriestoremainactivebygardeningintheirsmallvegetablepatch.SheandherhusbandliveinasmallvillageontheoutskirtsofCapeTown.Theyalsohaveadog.Twogrown-updaughtersliveindepend-entlyinPortElizabeth.Shedeveloped

nocturnaldyspnoeaandankleoedema,beginningfouryearspreviously.

William Williamis60yearsoldandworksasasecurity

agenttakingcareofofficebuildings.At30yearsold,hecametothecityfromasmallvillageintheTranskeiandfrequentlywentbacktoseehiswifeandchildrenwhohadnotmadethemovewithhim.

Williamisaheavysmoker.Hewasdiagnosedwithhavinghypertensionattheageof50.Duetohisworkandlivingconditions,hedidnotcomplywellwiththetreatmentreceivedfromthelocalhospitalclinic.Hedevelopedbreathlessness,andfurtherinvestigationsrevealedthathehad

leftventricularhypertrophy.Hisconditiondeterioratedandheisnowliv-ingwithhisthreesonswhocametothecityaftertheirmotherdied.

George Georgeis65yearsoldandaretiredbankman-

ager.Hehasbeenveryfitinthepastbutbecameawareofchestpainsandsomeshortnessofbreathwhenexercising.Helovesplayinggolf,butfounditincreasinglydifficultbecauseofthelongwalksandhavingtostopattimesbecauseofpainorshortnessofbreath.Heliveswithhiswifeanddaughterinanup-marketpartofCapeTown.Investigationssupportedthediagnosisofcoronaryarterydisease.

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