1601006079

 A 46 year old female who is a housewife and a resident of nalgonda came to the Hospital with chief complaints of shortness of breath, and cough since 5 days

HISTORY OF PRESENTING ILLNESS-

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

Associated with orthopnea, wheeze and paroxysmal nocturnal dyspnea

cough with expectoration since 5 days  which was insidious in onset

PAST HISTORY-

Known case of COPD since 12 years and is on inhaler

GENERAL EXAMINATION-

raised JVP

RESPIRATORY SYSTEM EXAMINATION -

Inspection-normal

Palpation-normal

Auscultation-bilateral decreased breath sounds and bilateral rhonchi and crepitations present at infrascapular and infraaxillary areas



CVS EXAMINATION-

Inspection-normal

Palpation-

left parasternal heave

palpable P2

apex beat at 5th intercostal space ,lateral to midclavicular line

Auscultation -

S1,S2 heard

Loud P2




FINDINGS-

-Right atrium and ventricle-dilated

-RVSP 85 mmhg

-Severe TR with PAH


Provisional diagnosis- cor pulmonale

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