1. CASE
A 21 years old known cardiac patient for the
past six years on Lasix, spironolactone,
enalapril, monthly benzathine penicillin and
follow up in GUH
Currently presented with worsening
shortness of breath of one week duration. It
was initially while she was going to school but
now at rest. ass’ted with this she has
orthopnea of 2-3 pillow, PND ,palpitation but
no leg swelling
2. Cont’d
She has dry cough and intermittent coughed
up blood but no fast breathing, chest pain
She has no fever, recent migratory type of
joint pain
She has no hx of GI or gu manipulation or no
hx of sweating, malaise, reddish discoloration
of urine
She is adherent to her medications and
dietery advice
3. She has no neck swelling or hx of hot or cold
intolerance
She has no self or family hx of HTN
She is single and didn’t get pregnant
She has no BV, tinnitus or vertigo
p/e
G/A- in cardiorespiratory distress
v/s- Afebrile, BP=90/60
4. Cont’d…..
Chest: basal criptation bilaterally
Cvs:
Arterial pulse is low in volume and it is
irregularly irregular
Jvp is raised
AI Is not visible but PMI is at 5th ics,at MCL, and
it is tapping.
P2 is palpable
There is apical diastolic thrill
There is parasternal heave
5. Cont’d…..
Auscultation reveals:
Loud s1,p2
Grade 4, rumbling, mid diastolic murmer, best
heard at the apex, and accentuated by expiration
Abdomen :no hepatosplenomegally
MSS: bilateral G1 leg edema
IS: bilateral erethamathos skin over her check
Based on the above evidence answer the following
Q.?
6. Cont’d…
1. Write full ass’t of this pt?
2. Did she has a precipitant? If yes what is z
precipitant?
3. What is the murmur of this patient?
4. What important investigation do u want to send??
ANSWER
1 NHYA CLASS IV STAGE C CHF 20 TO VHD
2ARRYTHIMIA
3MS
4 ECHO C X RAY ECG
