A 32 year old patient



A 32 year old male patient resident of suryapet came with 

C/o pedal odema from 1 month and sob at rest from 1 day.

Patient was apparently asymptotic 1 month back then developed B/l pedal edema sudden in onset,yellowish discolouration of eyes and decrease appetite with out any investigations they took herbal medications for jaundice for one day and got relieved from symptoms and patient started taking alcohol then after till yesterday.

Pedal edema - B/l , pitting type , sudden in onset , extended upto knee.

SOB - sudden in onset , . Palpitations , sweating and giddiness + , not associated with  chest pain ,Orthopnea and PND

No H/o Fever , cough , pain abdomen , nausea , vomitings, loose motions or decreased urine output.

N/k/c/o - HTN , DM II , TB , epilepsy, CVA , CAD.

H/o surgery 2 years back - for right inguinal hernia.

Personal history:

Appetite normal

Diet mixed

Bowel and bladder regular

Sleep adequate

Alcoholic from 20 years(daily intake of 90ml / day)

Smoker from 20 years ( 18/day)

General examination:

Patient is conscious, coherent and cooperative.

B/l pedal edema (pitting type upto knee ) +

No pallor icterus ,cyanosis ,clubbing , lymphadenopathy .

Vitals:

Temp 98.6F

Pr- 98bpm

Bp-150/90mmHg

Rr- 26cpm

SPO2 - 99%

GRBS- 104mg%

Systemic examination:

CVS - S1,S2 heard 

           Parasternal haeve +

           Jvp- Raised

           Apex beat : 6 thICS lateral  to mid clavicular line

         Ejection systolic  murmur

RS - vesicular breath sounds +

          Decreased on Right infraaxillary and infrascapular region

           No wheeze or adventitious sounds

P/A - Obese

         No tenderness

         Liver palpable below right costal region 1 finger

         No free fluid.

CNS - NAD









4 am ECG
ECG at 5 am 

 V3R and V34 ECG @10:30am




Day 2 after pleural tap for diagnostic purpose




provisional diagnosis : right heart failure with moderAte  PAH with? ASD with ?alcohol liver disease with alcohol and tobacco dependence 






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