Asd

1. CASE PRESENTATION
Presented by – Dr. Piyush Chopra
Junior Resident 3
Department of Internal Medicine
HIMS, Sitapur
Moderator- Dr. Nishant Kanodia
HOD & Professor
Department of Internal Medicine
HIMS, Sitapur

2. • Patient name Mrs. Ram rati 47 year old female resident of sitapur,
hindu by religion. She is a homemaker. History has been given by the
patient herself.
• Chief complain of – Breathlessness since 2 years
Chest pain since 2 years
Decreased appetite since 1 year

3. • HOPI- Patient was apparently well 2 years back then she started
developing Breathlessness which was insidious in onset, gradually
progressive from NYHA CLASS I to III i.e. earlier she used to had
breathlessness on exertion i.e. on climbing stairs , carrying something
heavy to now on daily routine activities like bathing etc. This
progression occurred over 2 years . History of pedal edema on & off
but not present at time of presentation. No history of orthopnea
/PND .
• No history of cough , no seasonal or diurnal variation of
breathlessness. No history of fever. Breathlessness relieved on rest
which is associated with easy fatiagability

4. • Patient also complained of chest pain ,which was diffuse and on left
side of chest pain, was on /off and associated with palpitations . No
radiation to arm, neck or jaw. Relieved by taking rest . Patient
complained of decrease in appetite since 1 year
• Earlier she used to take 2 chapatis with a bowl of fal/ sabzi but now
reduced to ½ or 1 chapatti , not associated with any fever, nausea ,
vomiting , diarrhoea , constipation.
• No history of syncope or dizziness , no history of squatting episodes .
• No history of sweating , no history of heat intolerance, no history of
any bleeding in stools or black colour stools .No history of recurrent
respiratory Infections . No history of decreased urine output , rashes
or joint pain

5. • No history of any sudden onset exacerbation of breathlessness, no
history of any stroke in past.

6. • Past History – No History of T2DM, HTN ,ATT, Any thyroid disorder
• Menstrual History- Menarche at 14 years , 28 days cycle , normal flow
• Obstetrics History- P3L3A8
All 3 male delivered by normal vaginal delivery at home,
the youngest son is of 22 years . All pregnancies were uneventful.
• Personal History- Mixed Indian diet
Normal sleep 6-8 hours with no night awakening episodes.
No addiction
Normal bowel and bladder habits
• Surgical History- No history of any surgery in past.

7. • Summary- 47 years old female resident of sitapur , homemaker, known
case of presented to hospital with chief complain of gradual onset ,
progressive breathlessness since 2 years with no orthopnea /PND. She
also complained of chest pain , left sided with no radiation to any area,
associated with palpitations on /off and decrease in appetite

8. Differential Diagnosis
• Serum Anaemia with heart failure
• Valvular heart disease with RHD
• Adult presentation of congenital heart disease
• Pulmonary hypertension

9. Examination
• Patient is calm, quiet , conscious well oriented to time place, person
• Patient is lean and undernourished
• Ht-160 cm
wt-43.7 kg
BMI -17.1
Pulse – 95 bpm, regular , low volume , no radioradial or radiofemoral
delay . All distal pulses palpable

10. BP- Rt Arm 98/66 mmHg Rt leg -122/78 mmHg
Lt Arm 100/64 mmHg Lt leg – 120/76 mmHg
Taken in supine position
RR-14/min , temp -98.6 F , SPO2- 99% @ RA
thoracoabdominal axillary

11. • Hair – Normal , no sign of alopecia
• Eyes- No Icterus, pallor present , proptosis +
• Nose- No cyanosis,
• Nails – clubbing absent
• Lips – No cyanosis
• Mouth – No ulcers, glossitis
• Neck- No swelling, Neck veins not engorged
JVP not raised
No palpable Lympnode

12. • CNS
Inspection –
Chest wall- B/L Symmetrical , no scar marks, no visible veins , no spine
deformities
Palpiataion – Apical impulse-5th intercostal just lateral to medial to
midclavicular line
No parasternal heave
Epigastric pulsations present (felt on tip of finger)

13. • ABDOMINAL
- Soft non tendeer on superficial palpation
Palpation
- Tenderness present in right hypochondrium on deep palapation
- Liver was palpable and finger below lower costal margin in mid
clavicular line.
-Live span -18cm. Pulsatile liver present
Spleen – palpable 3 finger below lower costal margin
No shifting dullness, no fluid thrill.

14. THANK YOU