Valvular heart disease - RHD

 41/F patient came to hospital with 

C/o shortness of breath since 12 years 

Heaviness in chest since 12 years 

Patient was apparently assymptomatic 12 years back then while farming suddenly she developed shortness of breath - sudden in onset , gradually progressive , assosciated with heaviness in chest .no palpitations ,no sweatings ,no pedal edema ,no cough .

She then consulted a local doctor and was said to have dust allergy ? .

As her symptoms didn't resolved she consulted cardiologist - and was said to have cardiac disease and on medications .

Patient experiences sob every 2 monthly ,with heaviness in chest .

No pedal edema 


Shortness of breath is gradually progressive - initially patient experienced sob on exertion ,now progressed to sob on activities like washing clothes,sweeping floor , on climbing stairs ,1 month back patient developed sob while sleeping that progressed and got hospitalised .

Since 10 days patient is having orthopnea ,Sob on sweeping floor and presented to us .

No history of seasonal variation of sob ,not associated with cough ,wheeze ,chest tightness.

Patient had history of epilepsy 4 years back ,used medications for 3 years and stop after consultation .


Non diabetic ,non hypertensive .


Provisional diagnosis - ( progressive LV failure ) 

1- chronic left ventricular disease 

2- valvular diseases 


On examination - 

No pallor ,no icterus ,no cyanosis ,no clubbing ,no edema .

PR-98/min , regular ,normal rhythm ,volume 

Bp- 80/50 mmHg 


Cvs- 

On inspection - 

Precordium normal 

Apex visible at 5th Ics at mid clavicular line 

No visible pulsations ,sinuses ,scars 

No JVP

On palpation - 

Apex impulse felt at 5th ICS - tapping type ,at mid clavicular line ,localised .

No parasternal heave 


On auscultation - 

S1,S2 heard in all areas 

No mumurs 










2d echo - moderate MS with mild MR 

Dilated LA ,LV 

No TR 

EF - good .

Comments

Post a Comment

Popular posts from this blog

Acute AWMI -?Wrap LAD

Image
 35 year old male patient who is a welder by occupation  Was apparently alright  2 days back then he developed chest pain on 19/1/2021 at 11 am ,chest pain was reterosternal diffuse ,dragging type ,severe assosciated with profuse sweatings , palpitations ,shortness of breath -acute onset,severe and was unable to complete full sentence . No syncope ,no pedal edema ,no wheeze ,no chest tightness. He is chronic alcoholic since 5 years ,consumes daily after work . Non smoker . He visited a local doctor ,got some analgesics .He felt comfortable till 3 am the next day ,when he again developed severe chest pain associated with sob and was sleepless .He couldn't visit any hospital . The next morning patient went to back to the same doctor ,and he was given loading dose and referred here . Patient presented to our casualty with severe chest pain,pain scale 10/10 with sob . Vitals -BP-100/70 mmHg ,PR-70/ min ,RR-21/min  Sats-95%  Ecg - showed ST Elevation in inferior and ...
Read more

52/M with valvular heart disease

Image
 50 year old male patient who is a farmer by occupation presented with complaints of  1- shortness of breath since 4 years  2- palpitations since 4 years . Patient says he had  chest pain 5 years back - diffuse ,squeezing and severe  for 1 day -for which he visited a doctor and was said to have MI ? Patient experienced severe shortness of breath 4 years back -at 12 am  - sudden in onset ,severe and lasted for half hr to one hour  ,he woke up and walked for few minutes and took rest .In the mrng patient went to hospital and was said to have cardiac disease ?  Later on he was put on medications and  was on regular follow up . Shortness of breath gradually progressed over 4 years -  Since 5 months patient is  experiencing shortness of breath - on exertion ( farming ,on lifting heavy weights,walking for long distance ,climbing stairs) . patient work has been gradually declined over 5 months ,as he says he becomes dyspneic on doing heavy...
Read more