HEART FAILURE -2

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Iam Sameera of 8th semester .I have been gien this case to analyse of which the entire details are given in the link below

                https://himabindu5.blogspot.com/2020/05/hello-everyone.html

ANALYSIS OF THE PROBLEM:

Cheif complaints 

• Chest pain since 2 months
• Palpitation since 2 montha
• Dyspnea
• Bilateral pedal edema extending till ankle
• Decreased urine output

       Chest pain

           # towards left

           # more in epigastric region

           #non radiating 

1.CHEST PAIN: lets see the causes

as per the chief complaints we get to know that the chest can be of cardiac or respiratory since there are plapitations and pedal edema

CAUSES EXCLUDED:

1.vascular; as there no other symptoms suggestive

 

                                          

2.neural causes: no evidence of neurological deficit and herpes infestation manifestations

 

                                                     

3.musculoskeletal and gastrointestinal :since no symptoms suggestive of muscle pain , tenderness, joint pains and bowel abnormalities

                                          

https://www.google.com/imgres?imgurl=https%3A%2F%2Fwww.practicalpainmanagement.com%2Fsites%2Fdefault%2Ffiles%2Fimages%2F2012%2F10%2F25%2FScreen%2520shot%25202012-10-17%2520at%25201.17.46%2520PM.jpeg&imgrefurl=https%3A%2F%2Fwww.practicalpainmanagement.com%2Fpain%2Fother%2Fmusculoskeletal%2Freducing-musculoskeletal-disorders-through-ergonomics&tbnid=PyQllhL8I9EqnM&vet=12ahUKEwjixLHV7ODpAhUHPCsKHcIEBucQMygAegUIARDrAQ..i&docid=blW0Tjj1o49AYM&w=531&h=351&q=musculoskeletal%20disorders%20symptoms&ved=2ahUKEwjixLHV7ODpAhUHPCsKHcIEBucQMygAegUIARDrAQ

                                                        

https://www.google.com/imgres?imgurl=https%3A%2F%2Fwww.verywellhealth.com%2Fthmb%2FHBM6n3H7oySeGL10imgCaGBWldQ%3D%2F1500x1000%2Ffilters%3Ano_upscale()%3Amax_bytes(150000)%3Astrip_icc()%2Fwhat-is-wrong-with-my-stomach-4138111-5c454a7cc9e77c0001b21d85.png&imgrefurl=https%3A%2F%2Fwww.verywellhealth.com%2Fwhat-is-wrong-with-my-stomach-4138111&tbnid=hgnCD3H02LXsRM&vet=12ahUKEwimoKjw7ODpAhVTFHIKHVdqBJoQMygAegUIARD-AQ..i&docid=lGi5Ew_xbihNoM&w=1500&h=1000&q=gastrointestinal%20system%20symptoms&ved=2ahUKEwimoKjw7ODpAhVTFHIKHVdqBJoQMygAegUIARD-AQ

now it could be cardiac or pulmonary

                                    

https://www.google.com/imgres?imgurl=https%3A%2F%2Fwww.verywellhealth.com%2Fthmb%2FoJ9fgP0uiArOLRZwgWFxtg5XiJg%3D%2F1500x1000%2Ffilters%3Ano_upscale()%3Amax_bytes(150000)%3Astrip_icc()%2Fpain-with-deep-breathing-4129383-5c70220546e0fb00014361f6.png&imgrefurl=https%3A%2F%2Fwww.verywellhealth.com%2Fpain-with-deep-breathing-4129383&tbnid=0c23ofgMYkL9IM&vet=12ahUKEwj1qfST7eDpAhWXFHIKHUFgBLUQMygAegUIARD2AQ..i&docid=rezU1xHU_J6VcM&w=1500&h=1000&q=pulmonary%20chest%20pain&ved=2ahUKEwj1qfST7eDpAhWXFHIKHUFgBLUQMygAegUIARD2AQ

   

 

                                       

 

                                     

 

SO I THINK ITS CARDIAC KEEPING IN MIND THE OTHER CHIEF COMPLAINTS

(PEDAL EDEMA, PALPITATIONS) 

#ACCORDING TO THE ABOVE PICTURE TROPONIN IS NEGATIVE

#ACUTE CORONARY SYNDROMES AND ANGINA RULED OUT SINCE THE ONSET IS 2 MONTHS.

BUT IT CAN ALSO BE DUE TO ANEMIA AND THYROID DISEASE...as fasr as the complaints are considered there is no fatigue easily and symptoms of hypo or hyper thyroidism

           

2.PALPITATIONS

• pulse is feeble ireerugularly irregular rhythm

• ECG

Irregular rythm P wave absent  indicating atrial 

Right axisis deviation indicating enlarged heart

St elevation in v4 v5 aVR

        Jvp was raised and showed prominent a wave 

3.DECREASED URINE OUTPUT:

IN THIS CASE THIS WOULD BE HYPOVOLEMIA

BUT LETS CHECK AND CORRELATE WITH INVESTIGATIONS.

AUSCULTATION FINDINGS:

                                Mitral area: Loud S1 heard

                                Tricuspid area: Loud S1 heard

                                Pulmonary area: Splitting of S2-loud P2 component

                -On X-ray imaging: Cardiomegaly - Enlargement of Rt. Atrium, Rt. Ventricle, Lt. Ventricle

                           

  -In 2D echo, Mitral valves calcification and fish mouth appearance was see

REFER:https://himabindu5.blogspot.com/2020/05/hello-everyone.html

BASED ON ALL THE ABOVE FINDINGS AND COMPLAINTS 

PROVISIONAL DIAGNOSIS OF MITRAL STENOSIS WAS MADE.

TREATMENT:

1.INJ.LASIX 2amp in 50ml NS @8mg/hr

2.oxygenation to maintain spO2 above 95%

3.nebulization with budecort 12th hourly

4.strict I/O charting

5.monitoring BP,PR hourly

6.fluid and salt restriction

7.head end elevation

8.inj.amiodarone 300mg (2amp) at 6ml/hr

9.inj.pantop 40mg/OD/iv

10.T. ecosprin 75mg/PO/OD