Concluded Case

Dilated Cardiomyopathy

Here is patient of 60 years, c/o breathless ness on exertion H/O PND . Bilateral pedal oedema pitting on pressure.extending up to knee. JVP,raised,fine rales present . Liver not palpable. Patient is not diabetic not hypertensive . Pulse ,66 / mt ,BP.120/70 CNS .Pt is disturbed die to sleeplessness, and confused . ABD..Constipation + X ray and ECG are attached. Need opinion .

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Concluded answer
poor progression of r wave in all leads is suggestive of impaired repolarization of ventricle and cardiomegaly ,low pulse rate , leg oedema are suggestive of dilated cardiomyoparhy.
All Answers
2DECHO is required to assess cardiac function. Blood tests including CBC, Renal function and NT-Pro BNP are essential... Start with diuretic treatment. Needs to treat constipation to reduce straining.
Thank you doctor
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ECHOCARDIUM TO CONFIRM DCM RX SALT & FLUID RESTN DIURETIC SACCUBITRIL + VALSARTAN DAPAGLIFLOZIN 5 MG ALPRAZOLAM AT BED TIME NOT TO STRAIN AT STOOL DUPHALAC 2 MEASUREFULL AT 6 PM
Chest x-ray showing widening mediastinum, Left apical hazyness, cardiovascular markings prominent, cardiomegaly. ECG- lead 1, AVL T wave inversion suggestive of lateral wall ischeamia, poor r progression.Twave flattening in v4to v6. Needed Sr electrolyts,cal,mg, TFT, lipid profile.
Thank you doctor
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poor progression of r wave in all leads is suggestive of impaired repolarization of ventricle and cardiomegaly ,low pulse rate , leg oedema are suggestive of dilated cardiomyoparhy.