BREATHLESSNESS,TACHYPNOEA,BILATERAL BASAL CREPS,Sp02=87%,ECG CHANGES

42 year old female came with complaint of brethlessness for 2 days. She was apparently normal 2 days back ,then she developed acute onset moderate breathlessness for that she went to a nearby hospital and treated symptomatically. She developed vomiting and Gidiness today morning for which she went to a nearby hospital .On examination she was found to have high BP , and was given TELMISARTAN (40 mg) and send home. After taking TELMISARTAN she reported an increased severe breathlessness. She gives a history of dermatitis in dorsum of both foot which ulcerated and she was given antibiotics.,Also complaints of bilateral pedal oedema and facial oedema while she was on treatmnet for dermatitis, which soon subsided (within a day) . The wounds are currently healed . She is currently on antithyroid medication.She stopped taking medicines 6 days back(for no relevant reason) She underwent thyroidectomy at the age of 17 . No relevant travel history. No relevant contact history. No similar illness among family members. O/E: GENERAL EXAMINATION: Oxygen saturation = 87%( Inhalational oxygen started immediately ,2L) Saturation improved after 10 minutes and gradually reached 95%. T= 98.2°F Pulse= 111 bpm BP= 168/122 mmHg RR= 50/minute,Thoraco abdominal, Tachypnoeic SYSTEMIC EXAMINATION: RS: Bilateral basal crepitations CNS: NFND CVS: S1,S2 heared Lasix 40 mg IV given Nebulisation with Duolin +Foracort given. ECG taken.........T inversion at leads I,aVL,V2-V6 Chest X-ray shows .......Obliteration of left costophrenic angle. Blood pH= 7.41, pCO2=35mmHg,pO2= 80mmHg Bicarbonate= 22.2 mmol/L,Lactate= 1.5 mmol/L. Provisional Diagnosis: LV dysfunction/Acute Pulmonary Oedema/Acute Pulmonary embolism /Infective causes. Please share your views on this case.....................

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Cardiomegaly LVH. Pulmonary edema Ecg showing NSR q in lead 2 , 3.slight changes of early repolarization. T wave inversion in lateral leads. Adv Echo CD and CAG. Treat for secondary infection.

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E cg- sinus rhythm, T wave inversion in lead 1, AVL,v2 to v6 . X ray chest PA view- cardiomegaly, hyperinflated lung fields, mediastinum widening. Adv CBC , LFT,kft, Bs-f pp, HBA1c, ECHO

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Anterioseptal mi leads to P.Odema

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