30 year old male with palpitations
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30 year old male presented to OPD with :
C/O - Palpitations since 1 week
C/o Shortness of breath Grade 3 since 1 week
C/o Cough since 1 week
30 year old male resident of nalgonda , poultry farm worker has h/o SOB and palpitations since 3 years.
His daily activities include getting up in the morning around 5 am , going to poultry farm and feeding hens . He has more of manual work and reported sob only on exertion before , which he thought was normal. In the evening patient consumes alcohol (90 ml whisky -daily) and goes to bed after dinner .
Shortness of breath since 3 years , insidious onset ,initially grade 2 and gradually progressed to grade 3 and unable to carry out his daily activites . Agrrevated on exertion and relived by rest .
Associated with orthopnea and PND .
C/o palpitations since 3 years . Aggrevated on exertion and relieved by rest .
Not associated with chest pain and pedal edema .
No h/o fever , sore throat or skin rash . No h/o decreased urine output , facial puffiness or frothy urine recently .
With these complaints , patient visited a local hospital and was told to have some valvular problem( no documentation available currently ).
He was advised to visit cardiologist and was put on symptomatic treatment .
Patient had symptomatic relief , so he continued his daily activities , and used to take medications whenever he felt discomfort .
Since one week , his dyspnea worsened and was not relived with medication .
Also c/o palpitations and Cough since 1 week . Non productive and more at night times.
He also reports generalised weakness ,fatigue and loss of appetite and weight .
With above complaints he visited our OPD .
PAST AND FAMILY HISTORY :
Patient was born in a low socio-economic family and had no complaints during childhood . He did report occasional fever , sore throat and cough during childhood which subsided with medications .
His father was a daily wage labourer and mother was house wife . Both of them have no h/o HTN ,DM, CAD, Valvular heart diseases .
He has 3 sibilings and none of them have any complaints or similar history .
Patient not a k/c/o HTN ,DM ,TB ,ASTHMA, EPILEPSY ,CAD,CVA .
PERSONAL HISTORY :
Loss of appetite present and disturbed sleep .
Regular bowel and bladder movements and
Daily consumes 90 ml of whisky . Non- smoker .
Since past 15 days ,pt had binge alcohol intake daily morning and evening .
GENERAL EXAMINATION :
SYSTEMIC EXAMINATION :
CARDIO-VASCULAR EXAMINATION :
INSPECTION:
Chest wall shape - Ellipsoid and b/l symmetrical
No Precordial bulge, Pectus carinatum/excavatum
No Kyphoscoliosis
No Dilated veins, scars, sinuses
Apical impulse - Visible in left 6 ICS 1 cm lateral to MCL .
Pulsations – epigastric, parasternal - absent
PALPATION:
Apical impulse – Tapping type ,diffuse .
Pulsations – No Epigastric pulsations
Parasternal Heave – Present - Grade 2
Diastolic Thrill in mitral area.
Palpable P2 - in pulmonary area .
AUSCULTATION :
Loud S1 and Loud P2 in mitral ,pulmonary areas.
??paradoxical split S2 .
Mid- diastolic murmur heard in Mitral area.
RESPIRATORY SYSTEM -
B/L NVBS heard .
B/L fine crepitations present IAA ,ISA .
CNS -
NO abnormality detected .
FINAL DIAGNOSIS :
HFREF with
SEVERE MS ( 0.8 cm2) secondary to ?? RHEUMATIC HEART DISEASE .
Severe PAH AND TR
ALL CHAMBERS DILATED WITH GLOBAL HYPOKINESIA .
MAT .
TREATMENT :
1) INJ LASIX 40 mg IV BD
2) TAB METOPROLOL 25 MG OD
3) Tab ECOSPRIN AV 75/40 mg OD
4) Fluid and salt restriction
5) Bed rest and avoid strenuous activity.
Advised - Cardiologist opinion and CTVS opinion, as requires immediate valve replacement .
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