critical case

1. Welcome to critical case presentation

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

4. Chief complaints
• Shortness of breath(SOB) for 15 days
• Generalized body swelling 10 days

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

7. • History of ischaemic chest pain 6 months ago

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

9. Past illness
• History of major chest trauma 10 yrs ago with
chest tube drainage
• No HTN or DM

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

11. Personal history
• Heavy smoker for 15 yrs((15pack/yr)
• Heavy alcohol drinking for 3 yrs
• Drug abuser for 3 yrs

12. Socioeconomic history
• Lower middle class family

13. examination

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

15. • Pulse :90 beats/min,Low volume, Regular
• BP:110/70mm Hg on supine
• Temp: Afebrile
• Rest rate :20/min
• JVP: Raised

16. Systemic examination

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

19. Diagnosis

20. Differential Diagnosis
• Left ventricular failure due to
– Ischeamic cardiomyopathy
– Alcoholic cardiomyopathy
– Drug abuse cardiomyopathy
• B/L Varicose vein

21. Investigation

22. ECG

23. CHEST X-RAY P/A VIEW

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

27. PLAN
• Treatment plan?
• Strategy for family screening

28. Thank you…..