35 year old with shortness of breath

CHIEF COMPLAINTS

A 35 year old who is painter by occupation came with chief complaints of shortness of  breath and fever since 1 week. 

HISTORY OF PRESENT ILLNESS 

Patient was apparently asymptomatic 1 week back, then he developed 
• shortness of breath on exertion, since 1 week.
• high-grade fever since 1 week, more during night, relieved on medication and relapses back.
• decreased urine output since 1 week
• dragging type of pain in both legs and hands, associated with generalised weakness.
• orthopnea and PND present since 4 days

HISTORY OF PAST ILLNESS

No history of DM, HTN, TB, Epilepsy, leprosy, CAD, CVN, Asthma or any other chronic illness.
No history of previous transfusion. 

PERSONAL HISTORY

Built : Weakly nourished
Appetite : Decreased since 1 week
Diet : mixed
Sleep : Decreased since 1 week 
Bladder movements: 
Anuria since 1 day associated with burning micturition.
Bowel movements: regular
Addictions : toddy consumer in summer season.
Regular alcohol consumer, once a week.
No h/o smoking

FAMILY HISTORY

His wife was diagnosed with pulmonary TB, got admitted in hospital 1 month ago. 

GENERAL EXAMINATION

Patient was coherent, cooperative and conscious. Well orientated to time and space.
Pallor : absent
Icterus : present 
Clubbing: absent
Cyanosis : absent
Koilynochia: absent
Pedal edema : absent
Lymphadenopathy: absent.




Vitals


SYSTEMIC EXAMINATION 

Respiratory system

Inspection 
Shape and symmetry of chest : normal, symmetrical 
Trachea : central
Respiratory movements: normal
Apical impulse: seen
Skin over the chest : normal
Dysnea : present

Palpation
Trachea : central
Respiratory movements: normal
Fremitus : normal

Percussion
Normal 

Auscultation
Breath sounds: vesicular
Adventitious sounds : absent 
Vocal resonance: normal on both sides
Infrascapular crepts present 

Other systems

CNS : No facial asymmetry, all reflexes are normal.
GIT : Tenderness present in hypochondrium, umblical and right lumbar region.
Liver and sleep not palpable.
Mild ascites.
CVS : Thrills , present
S1, S2 heard
No murmers.
Raised JVP. 
Parasternal heave present 


Investigations


 

ECG findings : Biphasic T waves in V1 - V4
T wave inverted in II, III, avf. 


Provisional diagnosis: Right ventricular failure with PAH ? AKI ? LIVER FAILURE???

Treatment: Conservative 


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