1601006188 SHORT CASE Medicine

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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)