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Case Presentation
By Anique Ali
History
History
A 44-year-old male presented to OPD with
Shortness of breath for 1 year
History
General Physical
Examination
Systemic Examination Investigations Treatment
History of Present Illness
• My patient was in his usual state of health 1 year back
when he developed shortness of breath which was
• More on exertion
• Progressive (first he could take stairs, now taking few stairs
causes worsening of SOB)
• Not associated with dyspnea on lying flat or sudden night
wakening due to dyspnea
• Associated with palpitations and chest pain
History
General Physical
Examination
Systemic Examination Investigations Treatment
Past
History• He has been admitted in hospital 3 times for syncope
• History of irregular heart beats since last year.
Treatment History
Lisinopril (ACE inhibitor)
Metoprolol 50mg/day
Aspirin 325mg/day
History
General Physical
Examination
Systemic Examination Investigations Treatment
• Personal History
• Real state agent
• Smoker
• Addict
• Family History
• Married, 4 Children
• H/O sudden death of brother at the age of 22
• Ischemic Heart Disease
History
General Physical
Examination
Systemic Examination Investigations Treatment
General Physical Examination
General Physical Examination
• A healthy looking man of average height and built is lying
comfortably in bed fully oriented in time, place & person
• Vitals
• Pulse: 94/min
• Blood pressure: 132/82
• Respiratory Rate: 22/min
• Temperature: 98°F
History
General Physical
Examination
Systemic Examination Investigations Treatment
• No Pallor, Cyanosis, Clubbing, Koilonychia, Leuconychia,
Splinter Hemorrhage, Pitting of nails.
• No Osler's Nodes, Heberden's Nodes, Bouchard's Nodes,
Joint Swelling, Deformitiy
• No puffiness, xanthalasmas, jaundice, rash, parotid
swelling, proptosis, hirsutism.
• No thyroid swelling, neck veins engorgement, JVP not
raised.
• No lymph nodes palpable. No Edema
History
General Physical
Examination
Systemic Examination Investigations Treatment
Systemic Examination
Cardiovascular System
• Pulse
Pulse is 94/min, regular, normal volume, but jerky with no radio-
radial or radio-femoral delay and vessel wall is not palpable.
• Inspection
No bulging, scars, visible pulsations.
History
General Physical
Examination
Systemic Examination Investigations Treatment
• Palpation
Apex beat is palpable in 5th ICS at mid clavicularline and is heaving
in character. No left parasternal heave. No palpable heart sounds.
• Auscultation
Normal first and second heart sound and fourth (S4) heart sound.
Grade 3/6 ejection systolic murmur that increased with the
Valsalva maneuver and decreases wit squatting was best heard in
the third intercostal space left of sternum.
History
General Physical
Examination
Systemic Examination Investigations Treatment
Resp. System, GIT and CNS
•Normal
History
General Physical
Examination
Systemic Examination Investigations Treatment
Investigations
Investigations
• ECG
• Echocardiogram
History
General Physical
Examination
Systemic Examination Investigations Treatment
• Asymmetric septal hypertrophy
• Mild systolic anterior motion of mitral valve with LVOT
obstruction was present
• Mild mitral regurgitation is also seen
• Right ventricle was of normal size and function
Diagnosis
Diagnosis
• Hypertrophic cardiomyopathy
History
General Physical
Examination
Systemic Examination Investigations Treatment
“
”
Thank you
Any questions?

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Case presentation HOCM

  • 3. History A 44-year-old male presented to OPD with Shortness of breath for 1 year History General Physical Examination Systemic Examination Investigations Treatment
  • 4. History of Present Illness • My patient was in his usual state of health 1 year back when he developed shortness of breath which was • More on exertion • Progressive (first he could take stairs, now taking few stairs causes worsening of SOB) • Not associated with dyspnea on lying flat or sudden night wakening due to dyspnea • Associated with palpitations and chest pain History General Physical Examination Systemic Examination Investigations Treatment
  • 5. Past History• He has been admitted in hospital 3 times for syncope • History of irregular heart beats since last year. Treatment History Lisinopril (ACE inhibitor) Metoprolol 50mg/day Aspirin 325mg/day History General Physical Examination Systemic Examination Investigations Treatment
  • 6. • Personal History • Real state agent • Smoker • Addict • Family History • Married, 4 Children • H/O sudden death of brother at the age of 22 • Ischemic Heart Disease History General Physical Examination Systemic Examination Investigations Treatment
  • 8. General Physical Examination • A healthy looking man of average height and built is lying comfortably in bed fully oriented in time, place & person • Vitals • Pulse: 94/min • Blood pressure: 132/82 • Respiratory Rate: 22/min • Temperature: 98°F History General Physical Examination Systemic Examination Investigations Treatment
  • 9. • No Pallor, Cyanosis, Clubbing, Koilonychia, Leuconychia, Splinter Hemorrhage, Pitting of nails. • No Osler's Nodes, Heberden's Nodes, Bouchard's Nodes, Joint Swelling, Deformitiy • No puffiness, xanthalasmas, jaundice, rash, parotid swelling, proptosis, hirsutism. • No thyroid swelling, neck veins engorgement, JVP not raised. • No lymph nodes palpable. No Edema History General Physical Examination Systemic Examination Investigations Treatment
  • 11. Cardiovascular System • Pulse Pulse is 94/min, regular, normal volume, but jerky with no radio- radial or radio-femoral delay and vessel wall is not palpable. • Inspection No bulging, scars, visible pulsations. History General Physical Examination Systemic Examination Investigations Treatment
  • 12. • Palpation Apex beat is palpable in 5th ICS at mid clavicularline and is heaving in character. No left parasternal heave. No palpable heart sounds. • Auscultation Normal first and second heart sound and fourth (S4) heart sound. Grade 3/6 ejection systolic murmur that increased with the Valsalva maneuver and decreases wit squatting was best heard in the third intercostal space left of sternum. History General Physical Examination Systemic Examination Investigations Treatment
  • 13. Resp. System, GIT and CNS •Normal History General Physical Examination Systemic Examination Investigations Treatment
  • 15. Investigations • ECG • Echocardiogram History General Physical Examination Systemic Examination Investigations Treatment • Asymmetric septal hypertrophy • Mild systolic anterior motion of mitral valve with LVOT obstruction was present • Mild mitral regurgitation is also seen • Right ventricle was of normal size and function
  • 17. Diagnosis • Hypertrophic cardiomyopathy History General Physical Examination Systemic Examination Investigations Treatment

Editor's Notes

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