2. Mrs. Nisamany , a 69 year old mother 0f three
from Alwai.
She is a house wife & diagnosed to have
Hypertension for last 10 years of duration.
She was apparently well with regular clinic
follow up & treatment untill 5 months back.
While on regular medication she devaloped an
atypical left sided chest pain where that
episode was lasted more than 20
minutes,with associated autonomic
symptoms but no radiation.
3. Since she was breathless & had alterd
sensorim, she was admitted to THJ within
hours.
After being admitted to the ED she was
transferred to the MICU where she had a 5
days of stay.
During her hospital stay she experienced
recurrent episodes of chest pain where she
was given IV medication & underwent several
investigations.
She gradually devaloped bilateral ankle
oedema & breathlessness wich responded to
medication within few days.
4. Her urine output was gradually reduced over
time but she was not offered any kind of RRT.
Her chest pain was not pleuritic in nature and
she denied any productve cough,episodes of
haemoptysis.
Pain was not radiating to the back.
She had no H/O any long journey prior to that
episode & she was bed bound.
She had a ward stay of 2 days inaddition &
she was refferdr to the cardiologist for
further evaluation.
5. After the discharge she was prescribed
several other medication & was asked to
fillow up in the clinic with certain life style
modifications.
She has no H/O stroke or TIA .
She denies intermittent claudication of lower
limbs
There is no recent H/O a sudden or incidious
dererioration of her vision.
She didn’t have F/O LUTS or BOO,
While on regular medication, after about 2
months she had a second episode of chest
pain …
6. ….which was ischaemic type & warrented her
a admission to THJ & subsequent MICU are
for the second time.
This time it was much dramatic & associated
with NYHA tpe 3-4 grade SOB.
UOP was also reduced markedly but managed
conservatively.
After 3 days of MICU care she recoverd &
cardiology refferal was made & she was
subjected to an USS of abdomen as well.
7. PMH- was not complicated with a H/O
DM,Dislipidaemia,BA,Urilithiasis or any
malignancies.
PSH- NOT significant.
Gyn Hx- she attained menuoause at the age
of 50 years.
DH-she had been on anti hypertensives &
lateron started on antianginals.Drug
compliance was satisfactory.
Dietary Hx-she is not a vegitarian.
Allergy Hx-not signiicant.
8. FH-there is no premature death due to a
acute coranary event among 1st degree
relatives.
SH-she doesn’t take alcohol.she has a fairly
good family support & her knowledge
regarding her current disease stasus is
satisfactory.
9. Not pale
Afebrile
BMI- 25.4 kg/m2
Not dyspnic
Not cyanosed
No B/L ankle oedaema
No xanthesma
No peripheral stgimata of IE
10. CVS Exam-
BP-170/90 mmHg, PR-88/min ,DR+, ESM+
Apex- 6th ICS in 2 cm lateral to MCL
All peripheral pulses present with no R-R or
R-F delay
No B/L fine basal crepitations
AS Exam- No organomegaly, No expansile or
transmitted pulsations, bruit + just above &
lateral to the umbilicus
RS Exam- unremarkable.
11. CNS Exam-No objective weakness of limbs,no
focal neurological deficites, Fundoscopy- L/S
9 ‘0clock position hard exudate+
12. A 69 year old lady with a H/O HTN on
treatment with good compliance has had 2
hospital admissions with subsequent MICU
care within 4 months duration. Hx was
complicated with NYHA grade 3-4 SOB &
oliguria. On clinical exam she had moderate
cardiomegaly, ESM+, abdominal bruit, & L/S
retinal exudate.
24. LVEF-60%
No RWMA
Concentric LVH+
Degenarative valves
Otherwise Normal study
25. Liver/GB/Spleen-Normal
Right kidney -7.8cm,smaller,CMD
Presserved,no supra renal masses
Left kidney-10 cm,echogenic,normal in
shape,normal CMD,Both kidneys no
hydronephrosi,no calculi.
Bladder normal,uterus normal,no ascites
Right renal artery doppler was not convinced
due to inadequate breath holding.
Right kidney is smaller than left,probable
renal artery stenosis cannot be excluded.
CTA would be helpful.
26. R-Kidney-7.6cm
L-Kidney-9.8cm
R/S Renal artery appear small in caliber from
hypoplastic R kidney
Both renal arteries show narrowing at the
ostea from the arota.
Diagnosis- B/L renal artery stenosis at the
site of origin
Sugest DSA & Balloon angioplasty of renal
arteries-Vascular refferal.
