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This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs

This E log also reflects my patient centre’s online learning portfolio and valuable inputs on the comment box is welcome.

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:


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