Concluded Case

Shortness of breath on exertion

A 23-year-old student complaining of shortness of breath on exertion. This has developed over the past 10 days, and she is now breathless after walking 50 yards. About 2 weeks ago she had a flu-like illness with generalized muscle aches and fever. She feels extremely tired and has noticed palpitations in association with her breathlessness. In addition she has some discomfort in her anterior chest which is worse on inspiration. Previously she has been extremely fit with no significant past medical history. There is no recent history of foreign travel. She denies substance abuse. On examination, her temperature is 37.5°C. Her pulse rate is 120/min and regular. Blood pressure is 90/70 mmHg. Jugular venous pressure is raised at 8 cm. Examination of her chest is unremarkable. Pressure over the sternum causes discomfort. ECG and chest X-ray are performed. The ECG shows T-wave flattening. What is the likely diagnosis? How would be further investigate and manage this patient?

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This patient has viral myocarditis due to Coxsackie B virus. The clinical picture of myocarditis is non-specific, but common symptoms include myal- gia, fatigue, shortness of breath, pericardial pain and palpitations. The prodromal flu-like illness is suggestive of this condition. The main clinical signs are those of cardiac failure. Patients usually have a marked sinus tachycardia disproportionate to the slight fever. ECG usually shows ST segment and T-wave abnormalities. There may be atrial or, more com- monly, ventricular arrhythmias or signs of conducting system defects. Diuretics and angiotensin- converting enzyme (ACE) inhibitors are used to treat cardiac failure. Bed rest is the treatment for the period of acute viral myocarditis.
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CXR = EMPHYSEMA CARDIOMEGALY BONY DEFORMITY = DEGENARATIVE CHANGES THORACIC SPINE SLIGHT SCOLIOSIS WITH CONVEXITY TO RT INVESTIGATIONS BLOOD ABG CBC PROBNP TROP I LUNG FUNCTION TEST IF.CAN BE POSSIBLE FOR HER SYMPTOMS ECG ECHOCARDIUM TROP I COVID I9 INDUCED CARDIOMEGALY / VIRAL CARDIOMYOPATHY SALIVA THROAT NASAL SWAB FOR COVID I9 COVID I9 rT PCR RAPID BLOOD AB TTEST IN VIEW HER RECENT FLU LIKE ILLNESS AFTER WHICH SYMPTOMS AGGRAVATED PL LOOK FOR PLEURAL RUB SHE GETS PAIN CHEST DURING DEEP INSPIRATION LOOK FOR S3 S4 HEART SOUNDS D = COPD CARDIOMEGALY ( POST VIRALCARDIOMYOPATHY ) CHF( GRADE III DYSPNOEA JVP RAISED TACHYCARDIA)
On auscultation there is a gallop rhythm, with a third heart sound.
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* Cardiomegaly. **COPD ** COVID 19 Needs further investigation and evaluation. First rule out COVID 19 Infection ,under these circumstances anxiety and mental agony may precipitate such sign and symptoms till reports proved otherwise. ECG,and cardiac hormonal studies can be useful. Till reports complied. Isolation and other protocol of covid Infection. Reassurance and counciling will give fruitful results.
Thanks Dr Dinesh Gupta
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Rotation of xray to lt Prominent bronchovascular markings bilateral Cardiomegaly Ecg is not available Lady seems to be asthmatic Secondaly she seems to be under scare of covid19 hence assess the case properly reassurance is required
ECG usually shows ST segment and T-wave abnormalities. There may be atrial or, more commonly, ventricular arrhythmias or signs of conducting system defects.
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COPD ,emphysematous chest Left CP angle unclear . Cardiomegaly . Cardiac border duplicated . Suggest RT PCR for COVID, troponin, d dimer, ECG ,ECHO , cardiac evaluation
Thank you ,Friends
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SUGGESTIVE. Of .. C. H. F... SECONDARY. TO ..VIRAL. CARDIOMYOPATHY... AND... FIBRILLATION / ARRHYTHMIAS....
Cops Emphysema Cardiomegaly Lt pleural effusion ? CCF Ad 2 DEcho for valvular lesion
Cxray shows changes of COPD emphysema with Cardiomegaly LVH. ECG ABG ECHO CD trop I
This patient has viral myocarditis due to Coxsackie B virus. The clinical picture of myocarditis is non-specific, but common symptoms include myal- gia, fatigue, shortness of breath, pericardial pain and palpitations. The prodromal flu-like illness is suggestive of this condition. The main clinical signs are those of cardiac failure. Patients usually have a marked sinus tachycardia disproportionate to the slight fever. ECG usually shows ST segment and T-wave abnormalities. There may be atrial or, more com- monly, ventricular arrhythmias or signs of conducting system defects. Diuretics and angiotensin- converting enzyme (ACE) inhibitors are used to treat cardiac failure. Bed rest is the treatment for the period of acute viral myocarditis.
Differential of T waves flattening is Hypokalemia, acute MI, The patient is tachycardic. With pulse rate of 120min /min X ray show mild scoliosis with rotation right. Trachea shifted left. Hyperinflated lungs. Cardiomegaly Prominent aortic knuckle without calcification Asthma attack Valvular heart disease. Secondary hypertension.
Admit the patient in ICU. RT PCR for Covid-19.
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