Chest pain and SOB



 Date of admission : 04 may 2022


A 34 year old male came to casualty with chief complaints of chest pain, shortness of breath since 4 days 

HISTORY OF PRESENT  ILLNESS

Daily routine of the patient :

The patient used to get up at around 7/8 in the morning, used to have breakfast  (Rice) and then used to go to drive auto. He then returns home in the evening and then used to consume alcohol daily before eating which was around 180ml and then sleep at around midnight at around 1/2. He used to binge watch TV until that time. 


His intake of alcohol has increased to 750 ml per day (which is due to family issues according to the patient) and stopped consuming food at night.


The patient  do not have habit of smoking


 4 years back he started noticing swelling in his hind limbs and he couldn't walk properly and experienced tingling sensation in fingers and went to hospital where doctors did a lumbar puncture and collected CSF and said there is accumulation of fluid over there.They gave them medications and patient continued to take medicines for 5 months and later he stopped taking them. After this he again started having alcohol and lost appetite ,had no proper food


Eventually the distension and swelling subsided and the patient started drinking again.


The patient has decreased urine output and pedal edema since 4 days.

   HISTORY OF PAST ILLNESS 


Not k/c/o HTN,diabetes, asthma,epilepsy

History of Pulmonary tuberculosis  7 years back subsided with ATT

Patient lost his consciousness ,fainted 5 years back and came to emergency  where cpr is done

 


PERSONAL HISTORY 


Married


Occupation:Auto driver


Appetite:Abnormal


Diet:mixed 


Bowel and bladder:regular


No known allergies


Alcohol history


-intake of alcohol /toddy  mostly daily


-180ml




FAMILY HISTORY 


Not significant 

PHYSICAL EXAMINATION 


No pallor,icterus,cyanosis,clubbing,lymphadenopathy

Pedal edema present

No ascites





Vitals

Temperature:afebrile


PR:74bpm

RR: 22/min

BP:120/90mmhg

Spo2:98%

Systemic examination : 


CVS- S1S2 +

Inspection - chest wall is bilaterally symmetrical

- No visible pulsations, engorged veins, scars, sinuses, carotid artery was prominent 

Palpation - JVP is not seen 

 Auscultation -  S1 and S2 heard


RESPIRATORY SYSTEM

- Position of trachea is central 

- Bilateral air entry is normal

- Normal vesicular breath sounds heard

- No added sounds

PER ABDOMEN 

- abdomen is non tender

- bowel and bladder sounds heard

Inspection - shape - scaphoid

Auscultation - bowel sounds heard


Provisional diagnosis : Right heart failure (cor pulmonale??) , MOD pulmonary arterial hypertension (PAH)


Investigations : 












Final diagnosis : Right heart failure, MOD severe pulmonary arterial hypertension (PAH)


Treatment : 

Fluid and salt restriction

Inj. Lasix 40 mg IV/BD ( only if SBP >110 mm of Hg)

Inj. Thiamine 200 mg in 100m/NS/IV

Inj.optineuron lamp in 100 ml/NS /IV

Inj. PAN 40 mg IV / OD

NEBc Duoline,Budecort,mucomist (8th hrly)


Strict T/O charging

Bp,Pr,spo2 monitoring 6th hrly

Tab. Pulmoclep po /BD

Salt restriction <4gm/dl

Syp. Grilinctum Bm 10 ml 5 ml PO /TID



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