202340251

 

 

 


Case History and Clinical Findings

PRESENTED WITH COMPLAINTS OF BREATHLESSNES SINCE 1 MONTH PEDAL EDEMA SINCE 1 MONTH

FACIAL PUFFINESS SINCE 3 WEEKS

 

 

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARENTLU ASYMPTOMATIC 1 MONTH BACK AFTER WHICH SHE DEVELOPED SOB WHICH PROGRESSED FROM GRADE 2 TO GRADE 3 AND NOW DYSPNOEA IS PRSENT EVEN AT REST

H/O ORTHOPNEA, AND PND PRESENT

H/O PEDAL EDEMA SINCE 1 MONTH ,EXTENDING TILL KNEE ,PITTING TYPE,GRADUALLY PROGRESSD TO ANASARCA

H/O GENRALISED WEAKNESS AND EASY FATIGUIBILITY PRESENT H/O DECREASED URINE OUTPUT

NO H/O FEVER,COUGH ,COLD

 

NO H.O CHEST PAIN,PALPITATIONS

 

 

PAST HISTORY:

K/C/O DM SINCE 10 YEARS(ON METFORMIN 500 MG) K/C/O HTN SINCE 15 YEARS(ON TAB TELMA 40 MG ) H/O CAD +

NO H/O BRONCHIAL ASTHMA,THYROID DISORDER

 

 

NO SIGNIFICANT FAMILY HISTORY

 

 

VITALS:

AFEBRILE ON TOUCH PR-120 BPM

BP-140/90 MMHG RR-26 CPM SPO2-84% RA GRBS-230 MG/DL

 

CVS -S1,S2 PRESENT NO THRILLS,MURMURS

APEX-LEFT SIXTH ICS LATERAL TO MID CLAVICUAR LINE

 

 

RS:

BAE+

NVBS HEARD

CREPTS PRESENT IN B/L ISA,IAA P/A:

SOFT,DIFFUSE TENDERNESS PRESENT BOWEL SOUND +

 

CNS :NFD

 

 

DEATH SUMMARY:

 

A 70 YEAR OLD FEMALE RESIDENT OF NALGONDA,WHO IS A DIABETIC AND HYPERTENSIVE WITH H/O CORONARY ARTERY DISEASE WITH COMPLAINTS IF BILATERAL LOWER LIMB SWELLINGS,SOB AND ABDOMINAL DISTENSION SINCE 1 MONTH WAS DIAGNOSE AS HAVING HEART FAILURE WITH REDUCED FRACTION (EF-26%) SECONDARY TO CAD,HTN,DM,WAS TREATED C0NSERVATIVELY BY FLUID RESTRICTION,BED REST,DIURETICS,AND DUAL ANTIPLATELETS WHICH SHE WAS USING WERE CONTINUED AND SHE IS HAVING PAIN ABDOMEN WITH DIFFUSE TENDERNESS .GENERAL SURGERY OPINION WAS TAKEN AND WAS ADVISED TO CONTNUE SAME TREATMENTAND NO ACTIVE SURGICAL INTERVENTION NEEDED OPHTHAL OPINION WAS TAKEN IN VIEW OF DIABETIC AND HYPERTENSIVE CHANGES BUT THE FUNDOSCOPIC WAS NOT DONE AS PATIENT IS IRRITABLE

HYPOKALEMIA WAS TREATED WITH POTASSIUM SUPPLEMENTATION AND WAS STARTED ON LASIX INFUSION AS PATIENT IS IN VOLUME OVERLOAD AND WAS ALSO KEPT ON CPAP AS SHE IS HAVING FEATURES OF PULMONARY EDEMA WITH TYPE 1 RESPIRATORY FAILURE .IN VIEW OF SEVFERE ANEMIA CAUSING HIGH OUTOUT STATE ,1 PRBC TRANSFUSION WAS DONE OVER 6 HOURS WITH PROPER DIURESIS PREVENTING OVERLOAD

ON 11/91/23,5 AM PATIENT SUDDENLY DEVELOPED VENTRICULAR TACHYCARDIA WITHY ABSENT PULSE AND BP NOT RECORDIBLE,SYNCRONISED CARDIOVERSION WAS PERRFORMED WITH 200 JOULES OF DC FOR 3 CYCLES WITH SIMULTANEOUS MEDICAL MANAGEMENT WITH MGSO4 AND LIGNOCAINE ,SOON WHICH CENTRAL AND PERIPHERAL PULSES WERE ABSENT AND RHYTHM NOT REVERTED ,CPR AS INTIATED ACORDING TO ACLS GUIDELINES AND EVEN AFTER 30 MINUTES OF CPR PATIENT COULDNT BE REVIVED AND DECLARED DEAD WITH ECG SHOWING FLATLINE AT 5:53 AM

IMMEDIATE CAUSE OF DEATH:

VENTRICULAR TACHYCARDIA (MONOMORPHIC) SECONDARY TO ACUTE ON CHRONIC DECOMPENSATED HEART FAILURE

ANTECEDENT CAUSE:

ACUTE ON CHRONIC DECOMPENSATED HEART FAIURE WITH CARDIOGENIC PULMONARY EDEMA WITH TYPE 1 RESPIRATORY FAILURE WITH ANEMIA WITH KNOWN CASE OF CAD,HTN AND DM

 

Investigation

7/9/23

HB:7.2 TLC:9400

N/L/E/M/B:65/24/01/10/0

 

PLT:4.4L ALB:NIL

BILE SALTS:NIL BILE PIGMENTS:NIL PUS CELLS:2-3

EPT CELLS:2-3

8/9/23

NA:140 K:4.4 CL:103 10/9/23 HB:8.7 TLC:14800 PLT:3.6 NA:138 K;3.6 CL:98

BLOOD UREA:35

SR CREATININE :1.4

 

 

USG ABDOMEN :

B/L PLEURAL EFFUSION

DIFFUSE EDEMA OVER ABDOMINAL WALL NO ASCITES

 

2D ECHO:

RWMA +,LADS AKINESTIC TERRITORY RCA WITH LCX HYPOKINETIC

MODERATE MR ,MODERATE TR WITH PAH.MILD AR SCLEROTIC AV ,THICKENED AV NO AS/MS

EF -26%

RVSP-52 MMHG

SEVCERE LV DYSFUNCTION PRSENT DIASTOLIC DYSFUNCTIUON PRESENT

 

NO PE

IVC - 2.53 CMS ,DILATED NOJNH COLLAPSING ALL CHAMBERS DILATED

Treatment Given(Enter only Generic Name)

1. FLUID RESTRIUCTION <1L/DAY

2. SALT RESTRICTION <1.5G/DAY

3. INJ LASIX 40MG IV/BD

4. INJ ZOFER 4MG/IV/TID

5. INJ PAN 40MG/IV/OD

6. INJ BUSCOPAN/IV/BD

7. INJ HAI PREMEAL SC/TID

8AM-2PM-8PM

8. TAB TELMA 40MG PO/OD

9. TAB SPIRONOLACTONE 50MG PO/OD

10. TAB ECOSPORIN.AV(75/10) PO/OD

11.    TAB IVABRADINE 5MG PO/OD

12.    INTERMITENT CPAP

13. STRICT I/O CHARTING

14.        ITALS MONITORING 2 HOURLY

15 COMPLETE BED REST


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