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A case of Dyspnea  Prof. Dr.  Mageshkumar  Unit (M1) Devendra Patil
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],No pallor , icterus , cyanosis , clubbing , lymphadenopathy , pedal oedema Neck veins were distended and  JVP elevated 8 cm
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[object Object]
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Cobb’ s  Angle : Approx  15
ECG ,[object Object],[object Object],[object Object]
Blood Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RBS : 134 mg% Urea 23 mg % Cr : 0.8 mg % Na : 145 meq/l K  : 4.2 meq/l
 
 
 
 
 
Ct findings ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Pulmonary Function Test ( done at ITM Chetpet ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
2D Echo Cardiography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ABG  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Analysis: pH in normal range Mild hypoxia Respiratory alkalosis  Normal Anion gap
Final diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
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PULMONARY HYPERTENSION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approved Agents  and side-effects Class of Drug Drug Dis-advantages CCB Nifidepine 180 – 240 mg/day Amlodipine 20 – 30 mg/day Hypotension, pedal oedema , palpitations ET -1 Antagonist Oral  Bosentan /  62.5mg bd Hepatic toxicity (11%; transient, reversible) C/I with glyburide , cyclosporine PDE-5 Inhibitor Sildenafil Citrate  (20,  40 or 80 mg tid) Headache, flushing, dyspepsia. Avoided with nitrates Prostacyclin analogue Inhalational Iloprost / Frequent  administration 6 to 9 times daily. Short t1/2. flushing cough  Prostacyclin analogue Sc  Treprostinil / Pain, erythema at infusion site Prostacyclin analogue IV  Epoprostenol / 20-40 ng/kg/min Indwelling central line and Pump (infection ,malfunction, flushing diahorrea, jaw pain
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THANK – YOU References : Crofton’s  5/e Harrisons 16/e Fishman’s  4/e  Braunwald 8/e

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Unusual Cause of Pulmonary Hypertension

  • 1. A case of Dyspnea Prof. Dr. Mageshkumar Unit (M1) Devendra Patil
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  • 15. Cobb’ s Angle : Approx 15
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  • 38. Approved Agents and side-effects Class of Drug Drug Dis-advantages CCB Nifidepine 180 – 240 mg/day Amlodipine 20 – 30 mg/day Hypotension, pedal oedema , palpitations ET -1 Antagonist Oral Bosentan / 62.5mg bd Hepatic toxicity (11%; transient, reversible) C/I with glyburide , cyclosporine PDE-5 Inhibitor Sildenafil Citrate (20, 40 or 80 mg tid) Headache, flushing, dyspepsia. Avoided with nitrates Prostacyclin analogue Inhalational Iloprost / Frequent administration 6 to 9 times daily. Short t1/2. flushing cough Prostacyclin analogue Sc Treprostinil / Pain, erythema at infusion site Prostacyclin analogue IV Epoprostenol / 20-40 ng/kg/min Indwelling central line and Pump (infection ,malfunction, flushing diahorrea, jaw pain
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  • 40. THANK – YOU References : Crofton’s 5/e Harrisons 16/e Fishman’s 4/e Braunwald 8/e