case presentation

1. Welcome to case presentation

2. A 25-Year-Young Man with
Exertional SOB and Chest Pain
Presented by
Dr.md.sajjad safi
Phase –B
UCC,BSMMU

3. Particulations of the patient
• Name :Md.khakon
• Age :25 years
• Address :Pabna
• Occupation: Student
• Married
• Date of admission:02-May-2016

4. Chief complaints
• Exertional breathlessness since 6 childhood
• Exertional chest pain for 1 ½ years
• Fatiguability for 1 ½ years

5. • Breathlessness
– Childhood
– Exertional
– NYHA stage 2
– Occasional dry cough
– No orthopnea or PND
– No allergy to dust

6. History of present illness
• Chest pain
– Left sided
– Exertional
– CCS grade 2
– Constricting and crusting
– Mild to moderate
– Persisted for few hours and non radiating
– Relieved by complete rest
– Associated with sweating and fatiguability

7. • No histroy:
– Chest trauma
– Suggestive of Rheumatic fever
– Syncope
– Dizziness or palpitation
– Allergy to dust
– Joints pain

8. Past illness
• History of similar episodes of chest pain
breathlessness during childhood while
running..reduced exercise tolerance

9. Family history
• All are in good health
• No sudden death

10. Personal history
• Non smoker
• Non hypertensive or diabetics

11. Socioeconomic history
• Lower middle class family

12. examination

13. General examination
• Anxious and depressed
• Co-operative
• Body built :Average
• Pulse :72beats/min,Regular
• Bp:120/80mm Hg
• Temp:Afebrile
• Rest rate :18/min
• JVP:Not raised
• No facial or gross anomalies

14. • No
– Anamia
– Jaundice
– Cynosis
– Clubbing
– oedema

15. Systemic examination

16. Cardiovascular system
• Precordium:
– Apex beat:left 5th ICS,midclavicular line
– Palpable systolic thrill at pulmonary area
– Palpable heave at left lower sternal border
– 1st heart sound normal
– 2nd heart sound muffed(P2 component)
– Ejection systolic murmur:(Grade 4/6)
• Pulmonary area
• Radiating to left infraclavicle region
• Associated with click
• Increased in inspiration

17. Other systemic examination
• Respiratory :bilateral lung bases clear
• Gastroenterology: no organomegaly and
ascites

18. Diagnosis

19. Differential Diagnosis
Congenital acyanotic heart diseases
– Pulmonary stenosis
– Atrial septal defect(ASD)
– Patent ductus arteriosus(PDA)
Aortic stenosis

20. Investigation

21. ECG

24. CHEST X-RAY P/A VIEW

29. ECHO

34. OTHER ROUTINE LAB
Hemoglobin 14.5%
Total count 10.5*109/L
Differential N67L25M6
URINE R/M/E Normal
RBS 4.3mmol/L
S.ELECTROLYTES Normal
S.creatinine 0.74mg/dL
ALT 22U/L

35. Final diagnosis
• Congenital heart diseases
– Pulmonary stenosis (moderate)

36. PLAN
• Cardiac catheterization

37. Thank you…..