2. A 42-Year-Old Man with SOB
and Generalized Body Swelling
Presented by
Dr.Md.Sajjad Safi
MD phase –B,Resident
UCC,BSMMU
3. Particulars of the patient
• Name :Mr. Salauddin
• Age :42 years
• Address : Chandpur
• Occupation: Businessman
• Married
• Date of admission:04-Feb-2017
5. • Breathlessness
– For 20 days
– Insidious onset and progressive
– NYHA stage IV
– Orthopnea or PND Present
– Associated with dry cough
– No allergy to dust
– Relieved by sitting and propped up position
6. • Generalized body swelling
– For 10 days
– Starting from both legs
– Gradually progressive to abdomen and face
– With low urine output
– Normal in color
– Associated with cough
14. General examination
• Anxious and dyspneic
• Co-operative
• Body built :Average with b/l legs varicose vein
• Anamia +
• Clubbing +
• oedema ++
• No Jaundice,cynosis and leukonychia
17. Cardiovascular system
• Precordium:
– Cardiac impulse in 6th ICS with healed scar marks
– Apex beat:left 6th ICS, 2 cm lat midclavicular line,
diffuse
– No Palpable systolic thrill, heave or P2
– 1st and 2nd heart sounds muffed
– Pansystolic murmur :(Grade 3/6)
• Mitral area and Tricuspid area
• Radiating to left axilla region
• High pitched with soft and blowing type
• Increased breath hold expiration
18. Other systemic examination
• Respiratory :bilateral basal crepts
• Gastroenterology: Ascites + (shifting dullness)
• Others systems : no abnormality detected
24. Echo finding
• All four chambers are dilated(LVIDd=69mm)
• Globular & severe global hypokinesia
• Delayed asymmetrical septal movement
• Severe LV systolic dysfunction(EF=27%)
• Spontaneous echo contrast in LV
• Grade I MR with central jet
• Grade II TR
• Mild pil.HTN(PSAP=38)
IMPRESSION: Feature suggestive of dilated cardiomyopathy(DCM)
25. OTHER ROUTINE LAB
Hemoglobin 13.4 %
Total count 10.5*109/L
Differential N72L22M4E2
Lipid profile Normal
URINE R/M/E Normal
RBS 5.2 mmol/L
S.ELECTROLYTES Normal
S.creatinine 0.84mg/dL
TSH 2.12 mIU/L
26. Final diagnosis
• Left ventricular failure due to
– Dilated cardiomyopathy(? Alcoholic)
• B/L varicose vein