1601006053



 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 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 ,paroxysmal nocturnal dyspnea

Anasarca since 5 days and cough with expectoration since 5 days  which was insidious in onset

PERSONAL HISTORY-

Chronic smoker since 20 years

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

No murmurs







FINDINGS-

Right atrium and ventricle-dilated

RVSP85mmHg

Severe TR with PAH


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