55yr female patient with shortness of breath.

https://himabindu5.blogspot.com/2020/05/hello-everyone.html

Her chief complaints are

 1.palpitations
2.chest pain
3.Shortness of breath


Palpitations.

 Based on anatomical locations of causes for palpitations


1. Cardiac

Associated with chest pain usually.
Causes:

  • Arrhythmias
  • Sinus tachycardia
  • Bradycardia
  • Atrial Fibrillation
  • Supraventricular tachycardia
Other signs and symptoms
  • Chest pain
  • Cyanosis
  • Odema
  • Dyspnea 
2. Vascular 

      Cause: Anemia

3.lungs

Cause
  • Pulmonary hypertension
  • Interstitial lung disease
  • COPD

Other signs and symptoms
  • Dyspnea
  • Wheeze
  • Cough 
  • Chest pain
  • Strider
4. other causes

  • Hyperthyroidism
  • Drugs-alcohol,coccaine, caffeine, amphetamines,smoking
  • Pregnant the induced hypertension 
  • Anxiety  
Most likely pathology and etiology at anatomical locations


 Cardiac causes:

 Most likely Arrythmia Bradycardia
  Positive history finding : 
  • irregularly irregular pulse
  • Elevated Jvp a wave indicates increase in right atrial pressure , could be increase in right ventricular end diastolic pressure or  increased resistance to right atrial contrarction ( triscuspid stenosis,  pulmonary hypertension)
  • CXR finding: cardiomegaly- right Atrium, right ventricle , left ventricle
  • ECG report: absent p wave 
  • Etilogy could be like this:
Dilated left ventricular cardiomyopathy causing systolic dysfunction , due to that cause pulmonary hypertension , right ventricular end diastolic pressure causing rt ventricle enlargement and rt atrial enlargement causing jvp  to rise. And bradycardia causing irregular pulse.


  • Edema: bilateral pedal edema upto ankles.


 Pulmonary cause:
  • Chest pain: might be due to pulmonary hypertension 
  • Dyspnea ,Wheeze and breath sounds on right side. Cause: PAH 
  • No other symptoms like cough,so can exclude lung causes
 Anemia:


  •  Patient CBP showed microcytic hypochromic anemia , reduced Hemoglobin levels 


Causes:

  • Anemia of chronic diseases
  •  Iron deficiency anemia (mostlikely)*
Can cause heart palpitations also.

Diagnostic and therapeutic options.

Diagnostic: 
  •  ECG to record cardiac rhythm
  • CXR 
  • Hemogram 
  • USS
Therapeutic:

  •  Furosemide inj to control edema
  • Digoxin (in refractory case
  • Anti asthmatic tip for sob

Other finding in thi patient 

LFT REPORT:

  • Elevated total bilirubin levels
  • Elevated direct bilirubin levels
  • Elevated AST 
  • Elevated alkaline phosphatase
  • ELEVATED ESR.
      Cause: 
       gall stones ( all phos/ unconj bilirubin)
       Alcoholic liver disease ( AST rise greater than ALT ).

Comments

  1. 1601006022May 28, 2020 at 9:09 AM

    Maam what about his other findings? In LFT he has elevated liver enzymes?

    ReplyDelete
    Replies
    1. 1601006022May 28, 2020 at 9:09 AM

      https://himabindu5.blogspot.com/2020/05/hello-everyone.html

      Delete
    2. 1601006022May 28, 2020 at 9:14 AM

      Any imaging of his abdomen in search of gall stones?
      Anything about alc fatty liver disease?

      Delete

Post a Comment

Popular posts from this blog

36M with diabetic neuropathy

Image
  This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.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.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment C/o Weakness in both upper and lower limbs since 6months Slurring of speech since 5 years Hopi: Patient is apparently symptomatic 5 years back then he developed stiffness in neak  And headache while carrying heavy weights on his head as his daily routine work . After 1 year he developed progressive weakness in arms and reached to a stage where he couldn’t lift a glass of water( according to patient). Weakness progressed to lower limbs in 1 year reached to a stage where he couldn’t get up...
Read more

NEPHROTIC SYNDROME WITH TYPE -I DM, HYPERTENSION,RIGHT PLEURAL EFFUSION

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.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.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment A 20 yrs old female who is a house wife was brought to the casualty with the C/O decreased urine output since yesterday  Swelling all over the body since 4days History of presenting illness: Patient was apparently asymptomatic 2 months back then she developed swelling of both legs and face, and got admitted in the hospital got treatment and discharged.4days back she had no urine output and swelling all over the body. Past history: K/c/o T1DM On examination Patient is conscious coherent and...
Read more

65 yr old male pt AKI ON CKD 2° TO HTN

Image
  Cheif complaints: A 65year old man came to hospital with complaints of fever on and off , tightness of abdomen ,facial puffiness since 15 days   History of present illness:  A 65 year old male toddy tree climber by profession was apparently asymptomatic 10 years back then he was had swelling and pain abdomen for which he was diagnosed with- lt sided inguinal hernia and got operated in some private hospital. Preoperative and postoperative period was uneventful  4 years back patient had complaint of giddiness for which he approached government hospital physician and was diagnosed Hypertension[170/90] and was started on some unknown medication  6 months back patient had complaint of bilateral pedal edema for which investigations were done and found his serum creatinine elevated (4.3 ) and proteins in urine  CT scan showed unilateral (lt)staghorn renal calculi and bilateral inguinoscrotal hernia  DTPA scan was done showing decreased GFR on left side( 12%...
Read more