Concluded Case

ACS with acute CCF with LRTI

65 years female with Acute onset breathlessness n RT sided chest pain, BP 190/100, SPO2 ON AIR 55%, BILATERAL CREPITATIONS UPTO UZ, TACHYCARDIA 140/MIN WITH ST-T CHANGES , CRP 66, RAISED TROPONIN I, X RAY IS SHOWN BELOW. GIVE YOUR DDs & management plan.

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Concluded answer
Cardiomegaly LVH Rt mid basal inhomogenous heziness seen. Findings sugg of hypertensive failure. Cilinical history of fever Travelling Contact with pneumonia patient Needs to to be taken. Adv Echo CD HRCT thorax Routine investigation Throat swab for covid 19 Sputum analysis Start broad spectrum antibiotics bronchodilators mucolytics oxygen /NIV. Diuretics NTG LMWH Further management as per progression.
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Xray chest shows floppy opacities rt lower zone discreetly seen Scalloped rt dome Cardiomegaly Lt costophrenic is opaque H/o raised bp with tachycardia St-t changes but in which leads Crp is raised Positive troponin i My impression is pt is hypertensive with cardiomegaly st-t changes looks to be LVH Positive troponin-i are not only in mi but increases when there is extensive alveolar tissue breakdown Here i feel rt lung damage is significant due to pneumonitis Lt basal congestion is seen So overall HTN/LVH WITH CCF AND RT LOWER LOBE PNEUMONITIS RX control bp Diuretics Broadspectrum antibiotics Pt is hypoxic put on intubation and ventilator R/o covid19
Thanx dr Prashanth Rallabandi
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Cardiomegaly LVH Rt mid basal inhomogenous heziness seen. Findings sugg of hypertensive failure. Cilinical history of fever Travelling Contact with pneumonia patient Needs to to be taken. Adv Echo CD HRCT thorax Routine investigation Throat swab for covid 19 Sputum analysis Start broad spectrum antibiotics bronchodilators mucolytics oxygen /NIV. Diuretics NTG LMWH Further management as per progression.
I agree
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Elderly person Accelerated HTN Chest pain, right sided Respiratory failure STT changes Raised Troponin Xray chest Right basal infiltrations and congestion. Cardiomegaly DD 1) HTN,Acute MI, LVF 2) Covid infection, pneumonia, MI, cardiac and respiratory failure
Thank you, Friends
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Bilateral congestion/infiltration with cardiomegaly and elevated troponin with st-t changes, possibly due to CCF.treatment to be instituted for failure including diuretics and ntg drip.
* BL ..INFILTRATIONS..WITH.. EFFUSION ON LEFT SIDE.. * HT .. LVH .. ? PNEUMONITIS.. ? COVID-19.. ? SARI.. NEED'S TO GO THROUGH.. PROTOCOLS..COVID -19 ..
Tnx Dr Shivraj Agarwal sir
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Elderly (other morbidties?) Acute sob with congestion st-t changes in ECG and X RAY shows cardiomegaly with left side effusion right hilar congestion with fluffy opacities D/d- hypertension with CCF (also rule out MI) with super added infection basal pneumonitis? Rx- stabilise the patient with INTUBATE and put on ventilator Diuretics and treat hypertension( NTG drip if (overload) Broad spectrum antibiotics. (r/o COVID-19) Start Anti platelets after rule out MI
X ray reveals pneumonitis rt lower zone. Pl get her covid test done. High index of suspicion. Pl get her 2d echo. Serial ecgs could be myocarditis. Is she a diabetic. Pl treat it as pneumonitis with appropriate antibiotics mucolytics & nebulization
Bilateral Pnumonitis with sepsis Send Sputum culture,CTPA rule out pulmonary embolism, Covid 19 Repeat ECG ,ECHO to do Start broad spectrum antibiotics,antihypertensives ,diuretics as per EF , nebulisation
Cardiomegaly Lt lower zone congestion Rt lower zone infiltration Spo2is very low, so must go foe COVID investigation
dx cardiomegaly ddx pneumonia,covid 19 pneumonitis management give diuretics
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