TAILIEUCHUNG - Ebook Tips and tricks of bedside cardiology (first edition): Part 2

(BQ) Part 2 book "Tips and tricks of bedside cardiology" presents the following contents: Exertional dyspnea, cyanosis and fainting, fever with chills and petechial spots; exertional dyspnea and sudden hemiparesis; retrosternal discomfort upon climbing stairs; recent increase in angina frequency;. | 3 Exertional Dyspnea Cyanosis and Fainting Patient Profile Age 32 Sex Female Built Lean Chief Complaints Progressively increasing dyspnea on exertion for the last 1 year. Coldness of hands and blueness of fingers since 3 months. Fainting on 2 occasions in the preceding 1 month. Relevant History There was no history of breath-holding spells or squatting episodes during her early life. There was no history of recurrent sore throat joint pains or prolonged fever during childhood or adolescence. There was no history of fever productive cough chest pain or hemoptysis preceding her recent worsening of symptoms. There was no history of palpitation and skipped beats or of orthopnea and paroxysmal nocturnal dyspnea. Physical Examination No pallor or jaundice or ankle edema Cyanosis and clubbing of the finger-nails Pulse 88 BP 104 70 Temp. 98 Resp. 24 Pulse regular low in volume and feeble JVP 5 cm above angle of Louis at 45 degrees Prominent a wave observed. CVS Normal apex beat sustained left parasternal heave Systolic pulsations visible in the pulmonary area S1 normal P2 loud and audible upto the apex. No S3 or S4 gallop sound heard Gr II VI soft systolic murmur adjacent to the sternum. Chest clear on auscultation no rhonchi or crepts. 118 Tips and Tricks of Bedside Cardiology An ECG was obtained. ECG Findings Tall R wave in leads V1 to V3 Deep S wave in leads V4 to V6 Peaked P wave P. pulmonale. An X-RAY was also ordered. X-RAY Findings Right ventricular enlargement Exertional Dyspnea Cyanosis and Fainting 119 hd Prominent pulmonary artery Normal pulmonary vasculature. Diagnosis PRIMARY PULMONARY HYPERTENSION Discussion A history of progressively increasing dyspnea on exertion raises the possibilities of chronic pulmonary disease congenital or valvular heart disease cardiomyopathy or pulmonary hypertension. If there is additional history of syncopal episodes outflow obstruction due to mitral stenosis aortic stenosis hypertrophic subaortic stenosis or pulmonary arterial .

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• Tips and tricks of bedside cardiology
• Tricks of bedside cardiology
• Exertional dyspnea
• Fever with chills
• Petechial spots
• Recent increase in angina frequency
• Systemic hypertension
• Exertional angina
• Early diastolic murmur
• Severe chest pain
• Tall male and early diastolic murmur