Pulmonary hypertension

 https://niharikapenukonda122.blogspot.com/2022/10/a-60yr-old-female-came-with-sob.html?m=1





60 year old female patient 



GM Blog: 60 year old female patient 


NOTE
This is an ongoing case and will be updated 
The reference link (if any) will be mentioned at the bottom.

Date of admission: 12-10-2022

CHIEF COMPLAINT: patient came to the opd with complaints of cold and cough since 6 days.
H/o fall on left shoulder 5days back.

Shortness of  breath since 5days.

HISTORY OF PRESENT ILLNESS-
Patient was apparently asymptomatic 6 days back.then she had cold and cough which relieved on medication.  5 days back she fell down from bed while sleeping  at around 5am in morning.  From next day she complaints of breathlessness  which is grade 1 MMRC and progressed to grade 3 MMRC and pedal edema since 4 days. No h/ o fever and headache.   She complaints of left shoulder pain ( due to fall) . No h/ o chest pain ,palpitations, orthopnea, pnd.

Yesterday she went to area hospital around 9am and her bp was 185/120mmhg and then referred to our hospital. On admission her bp was 220/90mmhg.

PAST HISTORY:

M/k/c/o HTN,DM,TB,Astma, thyroid and epilepsy.

H/o fall from bed while sleeping 1 year back.

PERSONAL HISTORY:
Married 
Works at post office 
Diet: mixed. ( Non vegetarian)
Moderately built and nourishment.
Appetite - normal 
Bladder movement- normal
Bowel movements- normal 
Allergy-no 
Addiction- no


FAMILY HISTORY:
Not significant 

GENERAL EXAMINATION:
Patient is conscious, coherent, co-operative.
She is well oriented to time, place and person. 
She is moderately built and nourished  
Pallor - present 
icterus absent
No cyanosis
No clubbing
pitting oedema ( bilateral pedal oedema) present ( grade 3)  
No Lymphadenopathy 

Vitals 

On admission 
PR: 98BPM
RR: 24Cycles per mon 
BP: 220/90 mmhg 
Temp: afebrile. 
Spo2: 98
Grbs: 193 mg percent 

Systemic examination: 
CVS: 
Thrills : no
S1 and S2 heard 
Cardiac murmurs absent

Respiratory system:
Dyspnea present
Position of trachea: central
Breath sounds: Vesicular 
Adventitious sound: rales ( crepts ) 1 rub 

Abdominal examination: 
Shape : obese 
Non tender
No palpable mass
Liver palpable
Spleen non palpable 

Central nervous system 
Conscious
Speech normal

Memory intact 

Power tone normal ( both upper  and lower limbs) 

No signs of meningeal irritation.

Reflexes : normal.

















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Investigations 











Provisional diagnosis:
Acute left ventricular failure?  Ischemic heart disease? 

Treatment: 


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