1601006186 (short case)

Demographics

Age - 46

Sex - female

Address - nalgonda

Occupation - housewife

present illness:

She was apparently asymptomatic 5days back then she developed shortness of breath which was insidious in onset, gradually progressive, aggravated on lying down, and relieved on medication.

Associated with wheeze , paroxysmal nocturnal dyspnea

Anasarca since 5days and cough with expectoration since 5days which is insidious in onset.

Past History:

Patient is a known case of COPD since 12yrs.

General examination:

Elevated JVP.

Respiratory examination 

Inspection-normal

Palpation- normal

Auscultation - bilateral decreased breath sounds and bilateral rhonchi and crepitations and present at infrascapular, infra axillary areas.

CVS examination 

Inspection -normal

Palpation

  -left parasternal heave

  -Palpable p2

  -apex beat 5th ICS lateral to the midclavicular line

Auscultation

  -S1, S2 present

  -Loud p2

  -pansystolic murmur along left lower sternal border

Chest X-Ray

ECG

right ventricular systolic pressure: 85 mmHg

Severe TR with pulmonary artery hypertension

Provisional diagnosis

Right heart failure secondary to COPD (cor pulmonale)