67yr / F, presented with low grade fever, chest pain, DOE, coughing out small 'stick like substance' off and on. CXR, ECG, Echo attached. Sputum AFB is negative, She is stage 1 hypertensive and non Diabetic.
Xraychest shows prominent bronchovascular markingssuggestive of copd coughing out small sticky substance is shading of bronchial epthelium. Her ecg on face of it looks normal except mild changes of Lvh due to hypertension.overall i will treat her copd with chest inf with antibiotic like Amoxyclav +tab pulmoclear +pulmclear syp and foracort rotahalers 200ug twice daily.
First u do ABG & Routin lab, cardiac marker, HRCT X ray shows copd. Ecg T wave inversion in ant. Leads. May i advise start inj. Solumedrol 40 mg. Od, inj. Aminophylline infusion, Inj. Lasix 40 mg stst & 8 hrly.nebulise pt. With flohel foracort 8 hrly & Tab Abflow 200 od. Broncho dialeter with mucolyte give. Control bp with antihyper tensive. If cardiac marker is positive then add antiplates. Station.
LVH by sokolov criteria however Echo is normal.... Xray chest is showing b/l ground glassing in lower zones with fibroreticular opacities... I would suggest an HRCT for her
Her scan chest Bilateral basal reticuoonodular shadows s/o iLD pic Fever may be due to sec inf
bilateral emphysematous lung fields ; long standing asthma or copd
This lady has a chest infection and mild lvh due to not treated hypertension treat chest infection with antibiotics like Amoxicillin 250 MGM TDs. Use asthalin Tab 2mg TDs ,I don't believe in cough syrups and treat hypertension with choice of anti hypertensive may be atenolol 50 mg daily and manage till controlled.
LVH, IHD, LVDD, PH with pulmonary oedema and Secondary infection.
Bronchiectatic changes in right lower zone. Needs HRCT scan thorax for clarification. May be tubercular sequelae also.
LVH/ inf lateral wall ischemia:echo normal Emphysema, bronchiectasis changes Rt mz/Lz/ Left mz Lz. Nebulisation, antibiotics if leucocytosis is present. CT chest advisable
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