Mitral stenosis case

1. A 35 years old male patient , Arjunbhai Rathod, residing in chanakyapuri sola, labourer by
occupation, belonging to poor socioeconomic class presented to surgery OPD with chief
complaints of
Pain in right groin since 1 day
Swelling in right groin since 1 year
Breathlessness on exertion since 6 months
Palpitation since 6 months
ODP- 1.) Pain in right inguinal region since 1 day
pain is colicky in nature, swelling is present in right inguinal region since 1 year
which gradually increased in size.
2.) Breathlessness since 6 months
sudden in onset , gradually progressive over 6 months, present on doing routine
work, orthopnea present, no h/o PND, not associated with cough
3.) Palpitations since 6 months
intermittent in nature, present on exertion, relieved on rest
Patient has no H/o fever, chest pain, hemoptysis, dysphagia, syncope.
PAST HISTORY
No h/o Hypertension, Diabetes mellitus, Tuberculosis, Thyroid disorder, seizure disorder.
Patient has h/o fever with sore throat and joint pain in childhood at 10 years of age for
which patient was on intramuscular injections every 21 days till 18 years of age.

2. FAMILY HISTORY: not significant
PERSONAL HISTORY: no Addiction, drug, allergic history present
GENERAL EXAMINATION: Patient is concious, oriented to time , place and person and
following verbal commands, average built.
Temperature: normal, Afebrile.
Pulse- 86/min(regular) palpated in right radial artery with no radio radial and radio femoral
delay
Blood Pressure- 110/70 mmhg in right upper arm in supine position.
Spo2- 98% on room air
RR- 16/ min, thoracoabdominal breathing
Bilateral pitting pedal oedema present.
No Pallor, cyanosis, clubbing, icterus, lymphadenopathy seen.
AIRWAY EXAMINATION: Mallampatti grade II, 3 Finger Mouth Opening, normal dentition,
Head and neck movements normal.
CARDIOVASCULAR SYSTEM
Inspection: no precordial bulging, pulsations, scars, venous dilation seen.
Palpation: Apex beat palpated in left 5th intercostal space medial to midclavicular line-
Tapping in character. No thrill or heave palpated.
Auscultation: heart rate-88/ min, LOUD S1 heard at apex, S2 heard.
Mid diastolic murmur heard at apex with bell of stethoscope, not radiating,
best heard in left lateral position and in expiration.

3. RESPIRATORY SYSTEM
Inspection: Trachea in midline, B/L chest movements equal with respiration, not using
acessory muscles of respiration
Palpation: Inspectory findings confirmed by Palpation, B/L tactile vocal fremitus – equal.
Auscultation: B/L vesicular breath sounds heard, no adventitious sounds heard.
CENTRAL NERVOUS SYSTEM- normal
ABDOMINAL EXAMINATION
Inspection: A swelling of 5x6 cm seen in right inguinal region, overlying skin reddened and
wrinkled, cough impulse not seen
Palpation: swelling of 5x6 cm palapted in right inguinal region , tenderness present, warm,
doughy in consistency, impulse coughing absent, swelling is irreducible.
Auscultation: bowel sounds present and heard.
PROVISIONAL DIAGNOSIS
A 35 years old male patient, Arjunbhai Rathod, labourer by occupation, with NYHA II , with
Mitral stenosis ( Rheumatic origin) presented with obstructed right inguinal hernia and is
posted for right hernioplasty sos laparotomy.