A CASE OF RIGHT VENTRICULAR FAILURE WITH ACUTE HEPATITIS..

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A 80year old woman presented with chief complaint of SOB grade IV and bilateral pedal edema.

HISTORY OF PRESENT ILLNESSES:

Patient was apparently asymptomatic 20 days back then she had history of fall by slipping on the floor and fell in sitting position.Then she had complaints of hip pain(left) and generalized weakness.

She could walk normally for 4 days but later had complaint of too much pain and confined to bed.

Later c/o SOB ,insidious in onset.initially only after walking but after few days there was sudden increase in SOB and taken to the local hospital for treatment where she was given Oxygen and improved.

Since 10 days ,unable to sleep at night and irrelevant talking .

HISTORY OF PAST ILLNESS:

history of covid 19,she experienced SOB ,cold and generalized weakness.

Diagnosed with hypertension 20yrs back

Diagnosed with diabetes 13 yrs back

Surgical history : Appendectomy done 45 yrs back

                              Hysterectomy done 20 yrs back

No history of blood transfusions.

PERSONAL HISTORY: 

Patient is on mixed diet.

Normal apatite

Bowls: regular

Micturition: normal

No insomnia

DRUG HISTORY:

patient is on medication for diabetes and hypertension.

FAMILY HISTORY:

no family history of diabetes, hypertension,asthma and heart diseases

GENERAL EXAMINATION:

Patient is conscious , coperative and coherent

Pallor

No icterus

No clubbing of fingers/toes

Edema of feet : present upto knees

Vitals: 

          Temp: 98.6°F

          RR : 18/min

           BP: 120/70 

           SpO2 : 98%

SYSTEMIC EXAMINATION:

 CVS : no thrills

           S1&S2 heard

             No cardiac murmurs

 Respiratory system : 

             Dyspnoea

             Wheezing

              Position of trachea : central

               Decreased breath sounds in left side

 ABDOMEN : 

               Obese

                No tenderness

                No bruits

                Bowel sounds : yes

                Liver : not palpable

                Spleen : not palpable

 CNS : 

            Concious

             Speech : normal

PROVISIONAL DIAGNOSIS :

Right ventricular failure with pulmonary arterial hypertension with acute hepatitis with k/c/o DM & hypertension

INVESTIGATIONS : 

ESR :25 mm/1st hr.       (5-20)

Reticulocyte count : normal

HEMOGRAM: 

HB : 8.2 gm /dl.      (12-15)

Total count : 11,700 cells/ column.   (4k- 10k)

Neutrophils : 80%

Lymphocytes: 10%

 Eosinophils: 4%

Monocytes:6% 

Basophils: 0

PCV : 24.3.  (36-46)

MCV: 77.2.    (83-101)

MCH : 26.2.    (27-32)

RBC Count : 3.15millions/count. (3.8-4.8)

SMEAR :

  RBC: Normocytic normochromic

  WBC : Neutrophilic leucocytosis

  Platelets : Adequate in no. & distribution

  Hemoparasites None

   Impression : Normocytic normochromic anemia                              with Neutrophilic leucocytosis

Serum creatinine : 1.8 mg /dl.  (0.6-1.2)

Blood urea : 52 mg /dl.             (17 -50 )

HbA1c : 6.9 

 LFT :

Total Bilurubin    0.69mg/dl

Direct Bilurubin   0.20mg/dl

SGOT(AST)   # 798IU/L

SGPT(ALT)   # 644 IU/L

ALKALINE PHOSPHATE   # 224IU/L

TOTAL PROTEINS  # 5.8 gm /dl

ALBUMIN    # 2.88 gm/dl

A/G RATIO    0.99

TREATMENT : 

Tab ECOSPORIN /AV/

INJ MONOCEF 1gm IV BD

GRBS 6th hrly

Tab METFORMIN  500 mg PO/BD

INJ ZOFEF 4mg IV /TID