A 60 year male with valvular heart disease

A 60 year old male farmer by occupation came to casualty with c/o shortness of breath since 2 years

Pedal edema since

Epigastric pain since 2 years

HOPI

Patient was apparently alright 2years back then developed sob which progressed to grade 3 sob nyha classification

Pedal edema involving ankles upto knees

Pain in epigastric region since 2 years

Past history

H/o an episode of pharyngitis 10 years back

Not a known case of DM,HTN,ASTHMA,EPILEPSY,THYROID DISORDERS

PERSONAL HISTORY-

Diet-mixed

Appetite-normal

B &B movements- regular

Sleep-normal

Addictions- nil

GENERAL EXAMINATION-

Patient is conscious, coherent, cooperative

Moderately built and moderately nourished

Oriented to time ,place and person

No signs of pallor,icterus,cyanosis,clubbing,koilonychia, lymphadenopathy

VITALS AT ADMISSION:

Afebrile

BP-110/60 mmhg

PR-68bpm

RR-18cpm

SYSTEMIC EXAMINATION-

CVS-

Inspection

Shape of chest- symmetrical

Trachea -central

No scars ,sinuses ,dilated veins

JVP not elevated

Palpation-

All inspection findings confirmed

Trachea -central

Apex beat- left 5th intercoastal space midclavicular line

Auscultation -

Loud S1,S2 heard

Early diastolic murmur

RS-BAE+, Normal Vesicular breath sounds heard

No added sounds

CNS-

No facial asymmetry ,all reflexes are normal

GIT

No hepatosplenomegaly,no ascites

Investigations

6min walk test-

Vitals before testing :

PR 64 bpm

RR 28 cpm

BP 110/60 mmHg

SPO2 99% @RA

Distance covered: 191.25 meters

Duration: 6mins

Vitals after testing:

PR 74 bpm

RR 34 cpm

BP 100/60 mmHg

SPO2 98%@RA

Comments

medicine case

This is 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 patients clinical problems with collective current best evidence based inputs A 79yr male presented to casuality with chief complaints of pedal edema since 10 days , shortness of breath since 5 days Patient was apparently asymptomatic 10days back then came with c/o Pedal edema since 10 days -pitting type ,shortness of breath since 10 days insidious in onset , grade 3(marked limitation in activity) ,Fever 7 days back which subsided ,Dry cough 7 days back which subsided. PAST HISTORY - K/c/o hTN since 10 yrs on regular medication-telmisartan 40mg H/o CVA 10 yrs back for which he was treated. Not a k/c/o diabetes , TB,asthama,cvd , epilepsy. PERSONAL HISTORY - Diet - mixed Appetite - n

case presentation

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 w

Medicine case

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