1601006048 SHORT CASE

 

Short case 1601006048


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Case -

A 45 year old gentlemen ,from ramanapet who is farmer by occupation came to the OPD with

CHIEF COMPLAINTS:

Bilateral Pedal edema since 3 months 

Shortness of breath (SOB) since 3 months

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 3 months back then developed  pedal edema,

Insidious in onset,

Bilateral ,gradually progressive from involving ankles to limbs  (grade1to grade 3 ), pitting type 

Aggravated   by walking and by end of the day,

Relieved by elevating leg, 

Then developed shortness of breath which is insidious in onset,gradually progressive  from grade 2 to grade 4 ,aggravated on lying down and on work  associated with  orthopnea ,paroxysmal nocturnal dyspnea.

PAST HISTORY: known case of hypertension since 2 years




 
CVS examination:
Inspection: 
 - jvp elevated


Shape of chest : normal
Trachea: appears to be central
Apical impulse: visible ,appears to be shifted from its normal position 


 
Palpation 
Trachea : central 
Apex beat : shifted outwards downwards 4-5 cm lateral to midclavicular line
Palpable p2
Left parasternal heave

Percussion:  
Right border of heart shifted 1vm away from right sternal border
Left border shifted ,4cm lateral to midclavicular line

Auscultation:                                                                    S1 ,S2 heard
No murmurs

ECG:




Chest  X ray:

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