Pulmonary Hypertension with BVF. *Chief Complaints* A 46 yr old female attended Mopd with progressive SOB and productive cough since 1 month with pedal edema since 10 days. No associated fever,chest pain,palpitation,Hemoptysis,Diaphoresis,pain abdomen etc. She is K/C/O Hypothyroidism and Br Asthma. No H/O HTN,DM,Substance abuse. Normal Menstrual Cycle. General Examination normal except B/l pedal edema and prominent Neck veins. Systemic Examination- B/l Infrascapular fine crepts with occasional Ronchi. Routine Ix was advised. Pt attended Mopd with reports showing- CXR - increased CT ratio suggestive of Cardiomegaly with b/l lower zone opacity. Sputum C/S normal flora. Rest blood Ix normal. ECG - multiple VPCs. 2D ECHO- 1. LV function is mildly depressed with estimated LVEF of 45%. 2. IVS and apex are mildly hypokinetic. 3. Right Atrium & Left Atrium are dilated. 4. Right Ventricle is dilated. 5. Moderate Tricuspid Regurgitation. 6. Severe pulmonary hypertension with calculated RVSP of 65mmHg +RAP. 7. Mild Mitral Regurgitation, 8. Trivial Aortic Regurgitation. 9. No LA/LV clot or pericardial effusion. NT Pro BNP not done. Pt started on conservative treatment.

A 60 yr old male who is a chronic smoker presented with Breathlessness, pedal edema , poor oral intake and personality changes since 5 days....vitals at presentation were BP-160/100 PR-106/min, spO2-85%, Rbs- 88....No h/o any comorbidity..comment on the approach to this patient...

76yr/M, kn HTN, DM, Hypothyroidism on Rx, Previously operated uneventfully- Ing hernia, TURP, and TKR At present admitted with h/o fever, dyspnea X 2day increasing. Conscious,T- 99.8, HR 96/min, BP 190/80, RR 30/min, SpO2- 84% on air. RBS 160. Rx: observation & continuousmonitoring. RBS, intake/ output, chart. Rx : Oxygen, Nebulisation, dytor, paracetamol, Pantocid, emset, antibiotics - zostum, clindamycine nabicard, cardivas, eltroxin . Labtest : CBC 12/ 12100 / 204000. Clotting & Electrolytes-wnl, sgpt 80 & creatinine 2.6 Trop-I neg, BNP- high. ECG and chest x-ray attached. please do interpretation of the ECG and x-ray and further Rx...

32 year old female. Known DM, Hypothyroidism, and bronchial asthma, presented to er with dyspnoea on exertion, a/w cough with expectorant and fever since last 10 days. H/O similar episodes in the past on and off since last 10 years which was her last child birth too at the same time was diagnosed with DM, hypothyroidism. Clinic ally Diffuse B/L wheeze with saturations 98% on room air Patient comfortable in rest but dyspnic on exertion Sputum for afb negative Outside tried for pleural tapping but nothing comes out The following is a x ray of her, Possible differentials All her symptoms started after the last child birth..

66yrs/M presented with 3 days of dyspnea.Known Diabetic and Asthmatic on budesonide inhaler.He has never smoked.No H/o fever,dry cough or travel.COVID 19 ÑEGATIVE,LAB REPORTS ENCLOSED.ANY THOUGHTS?