case presentation

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A 45 year old gentlemen ,from ramanapet who is farmer by occupation came to the OPD with

CHIEF COMPLAINTS:

B/l Pedal edema since 3 months 

Shortness of breath since 2 months

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 3 months back then developed  pedal edema, insidious in onset, bilateral ,gradually progressive from involving ankles to limbs  (grade1to grade 3 ), pitting type ,aggravated   by walking and by end of the day,relieved by elevating leg, then developed shortness of breath which is insidious in onset,gradually progressive  from grade 2 to grade 4 ,aggravated on lying down and on work  associated with  orthopnea ,paroxysmal nocturnal dyspnea.

PAST HISTORY: known case of hypertension since 2 years

 

CVS examination:

Inspection: 

 - jvp elevated

Shape of chest : normal

Trachea: appears to be central

Apical impulse: visible ,appears to be shifted from its normal position 

 

Palpation 

Trachea : central 

Apex beat : shifted outwards downwards 4-5 cm lateral to midclavicular line

Palpable p2

Left parasternal heave

Percussion:  

Right border of heart shifted 1vm away from right sternal border

Left border shifted ,4cm lateral to midclavicular line

Auscultation:                                                                    S1 ,S2 heard

No murmurs

ECG:

Chest  X ray: