1601006186 SHORT CASE

 

1601006186 (SHORT CASE)

Demographics
Age - 46
Sex - female
Address - nalgonda
Occupation - housewife


present illness:
She was apparently asymptomatic 5days back then she developed shortness of breath which was insidious in onset, gradually progressive, aggravated on lying down, and relieved on medication.

Associated with wheeze , paroxysmal nocturnal dyspnea

Anasarca since 5days and cough with expectoration since 5days which is insidious in onset.

Past History:
Patient is a known case of COPD since 12yrs.


General examination:
Elevated JVP.


Respiratory examination 
Inspection-normal
Palpation- normal
Auscultation - bilateral decreased breath sounds and bilateral rhonchi and crepitations and present at infrascapular, infra axillary areas.


CVS examination 
Inspection -normal
Palpation
  -left parasternal heave
  -Palpable p2
  -apex beat 5th ICS lateral to the midclavicular line
Auscultation
  -S1, S2 present
  -Loud p2
  -pansystolic murmur along left lower sternal border

Chest X-Ray

ECG

right ventricular systolic pressure: 85 mmHg
Severe TR with pulmonary artery hypertension

Provisional diagnosis
Right heart failure secondary to COPD (cor pulmonale)

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