1601006053 SHORT CASE
A 46 year old female who is a housewife and a resident of nalgonda came to the Hospital with chief complaints of shortness of breath since 5 days
HISTORY OF PRESENTING ILLNESS-
The patient was apparently asymptomatic 5 days back and then she developed shortness of breath which was insidious in onset,gradually progressive,aggravated on lying down and relieved on medication
Associated with orthopnea,wheeze ,paroxysmal nocturnal dyspnea
Anasarca since 5 days and cough with expectoration since 5 days which was insidious in onset
PERSONAL HISTORY-
Chronic smoker since 20 years
PAST HISTORY-
Known case of COPD since 12 years and is on inhaler
GENERAL EXAMINATION-
raised JVP
RESPIRATORY SYSTEM EXAMINATION -
Inspection-normal
Palpation-normal
Auscultation-bilateral decreased breath sounds and bilateral rhonchi and crepitations present at infrascapular and infraaxillary areas
CVS EXAMINATION-
Inspection-normal
Palpation-
*left parasternal heave
*palpable P2
*apex beat at 5th intercostal space ,lateral to midclavicular line
Auscultation -
S1,S2 heard
Loud P2
No murmurs
FINDINGS-
Right atrium and ventricle-dilated
RVSP85mmHg
Severe TR with PAH
Provisional diagnosis:
Right heart failure ?sec to COPD - CORPULMONALE
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