42M,progressive cough,dyspnea gr4,since 8days, travelled to kerala recently.spo2 84%on nasal 02.HR130,BP110/60,newly ムT2DM.whats possible diagnosis and treatment?




low voltage QRS complex in limb leads, T inversion in V3 - V5. X-Ray chest- pneumonitis/consolidation left mid zone, cardiomegaly, pleural effusion Rt. ABG- fully compensated metabolic acidosis, hypoximia, hypocapnia, hyponatremia, lactic acidosis, hyperglycemia. 2D- Echocardiography, CT Scan Chest, NT-ProBNP, complete sputum exam etc

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Bilateral pleural effusion with infiltrates in lt mid zone cbnat tapping congestive hepatomegaly free fluid in pelvis tachycardia hrct expiratory films travel history do sars covid 19 test CCF cirrhosis of liver CRF do lft rft ldh gfr thyroid thyroid disease DM

T wave inverted inv2 to v5 myocardial ischemia low voltge ecg pericardial effusion 2 decho

Cardiomegaly Features of myocarditis on ECG With congestion in liver Serositis Rv dilatation And involvement of lung parenchyma And the more important travelling history to Kerala in monsoon and particularly in these flood days I would like to investigate for leptospirosis Leptospira Ig M Plz post follow up

B/l bv markings prominence (left>right) Congestive Hepatonegaly with b/l pleural effusion Severe PH with dilated RV n RA T wave inversions in chest leads Its going towards Right sided HF and probably precipitated by an LRTI (Left lung field).... Diuretics with Antiobiotic support n ICU monitoribg

ECG: t inversion in chest leads with prolonged Qtc Rule out CHF first do 2d echo n cardiac enzymes and BNP and check out Mg and Ca Cxr CHF vs viral pneumonia or going into early ARDS Provide cbc and procalcitonin Abg is VBG sample Check out creat and Lft as pt is travelling to Kerala better to rule out leptospirosis after tht report. HCT and HB seems high check out cbc n rule out dengue also

A complicated case of Comorbid Covid 19 needs ICU Admission & Hyperboric Oxygen +Ventilator sos +Inj Decadron&Deriphylline prior to COVID test.

C H F Cardiomegaly Bilateral Pl effusion Pulmonary artery ++ Upper lobe veins prominent ECG Echocardiogram Blood PRO BNP Rx Fluid rest 1 L /24 hrs Salt 6gm/day Glyccemic control DIURETICS Valsartan- Sacubitril Beta.blocker O2 ..

Adv D Dimer & pulmonary scinti scan. Pt' echo shows RA & RV dialation with marked PH. & picture of congestive syndrome ,the lv function is compromised but no lv failure. breathlessness can occur in this setting due to microshower of emboli / resp infection.I don't see any evidence of leptospirosis/ myocarditis,as myocarditis will affect entire

ZLow voltage in limb and some precardial leads.T inversion past V3, qt prolongation, non homogeneous markings are predominantly on left, angle increased in right cardioplegic angle.HR disproportionate to saturation. Bronchitis with pericardial effusion .Adv Echo.Need more information on electrolytes , treatment given.

Needs a echo, the gas is venous so difficult to gauge degree of hypoxia however he is tachyapnic, the respiratory rate must be about 30. Non invasive ventilation with PEEP of 10 and PS of 10 to maintain sats of >88 %. Not unreasonable to drain the effusions for improveming respiratory mechanics. Emperic antibiotics could be considered.

What are we treating, sir?
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