1601006188 SHORT CASE

 

1601006188 SHORT CASE

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Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

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 A 46 yr old female, labourer by occupation resident of Nakirekal came to the hospital with

chief complaints of -

Shortness of Breath since 5 days and 

Generalized edema since 5 days. 


History of Present illness : 

      Patient was apparently asymptomatic 5 days back then she developed Shortness of Breath which was insidious in onset, gradually progressed from Grade 2 to Grade 4 (NYHA grading), aggravated on exposure to dust, cold, lying down(orthopnea) and wakes up in the middle of the night(PND) relieved on medication, associated with chest discomfort and Generalized Swelling  since 5 days, started in legs first then progressed to entire body.

Associated with cough with mucoid expectoration and wheeze since 5 days.

Past history: 

Similar complaints in past every 6-8 months

K/c/o COPD since 8 yrs and on inhalers

K/c/o HTN since 2 yrs and on medication (Telmisartan 80 mg OD)

ON EXAMINATION : 

Patient was conscious , coherent  and cooperative , moderately built and moderately nourished.

Pallor present

Icterus absent,

clubbing absent, 

cyanosis absent ,

koilonychia absent,

lymphadenopathy absent,

Bilateral pitting type of pedal edema is present upto the level of knee.




Vitals:

Temperature:-Afebrile

Pulse rate :- 91 bpm, regular rhythm ,voluminous

Blood pressure:- 110/70 mmHg, right upper arm in sitting position

Respiratory rate: - 28 /min, thoraco-abdominal

JVP:- raised 

Hepatomegaly

Ascites present.




CARDIOVASCULAR EXAMINATION:

Inspection -
   precordium appears to be normal.
Palpation - 
  Left parasternal heave
  Palpable P2
  Apex beat in the left 5th intercostal space    lateral to midclavicular line.
Auscultation -
  S1, S2 heard
  Loud P2 
  No murmurs 

RESPIRATORY SYSTEM :

Inspection -
Shape and symmetry of chest is normal
Trachea appears to be central 
Respiratory movements - rate is increased

Palpation - no tenderness or local rise of temperature
Trachea is central
Apical impulse in the left 5 th intercostal space lateral to midclavicular line.
Increased vocal fremitus is noted in the inframammary areas.

Percussion - dull notes were felt in the infraaxillary and infrascapular areas

Auscultation - bilateral decreased breath sounds and bilateral rhonchi and crepitations present in the inframammary, infraaxillary and infrascapular areas



CXR :
Lower lung consolidation
Perihilar hazziness
Enlarged central pulmonary artery


                    

  ECG:
     Right axis deviation
     Dominant S wave in V5
     P pulmonale
 

PROVISIONAL DIAGNOSIS:-
 Right heart failure secondary to COPD(Cor pulmonale)


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