#3 History ############################################################# Patient 3: This patient is a 67 year old man who complained of awareness of a rapid pulse rate, and a forceful heart beat. In addition, he reported that his exercise tolerance had decreased, and that he would get short of breath and fatigued more easily than ever before. He had no previous history of heart disease. A previous physical examination done a year ago had discovered a pulsatile abdominal mass, with an audible bruit in its vicinity. He had had good femoral pulses bilaterally at that time. Examination now confirms the presence of the pulsatile mass and bruit. The cardiac exam reveals a rapid heart rate with a very forceful apical impulse. There was a grade 2/6 systolic murmur heard at the apex and over the second intercostal space to the left of the sternum. No diastolic murmurs were heard. Prominent capillary pulsations were noted in the nail beds and under the tongue. Femoral pulses were present bilaterally, athough the left was weaker than the right. The patient was taken to the catheterization lab for confirmation of the diagnosis. #3 Data microvascular resistance 0.1 venous capacitance 70 venous zpvolume 1500 pmicro resistance 0.04 lv csystolic 0.2 rv csystolic 0.6 system volume 5500 system hr 120.0