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
V3R and V34 ECG @10:30am
provisional diagnosis : right heart failure with moderAte PAH with? ASD with ?alcohol liver disease with alcohol and tobacco dependence
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