Extreme fatigue, chest pain, dyspnea

An 82-year-old male, with a history of hypertension and benign prostate hypertrophy, presented with extreme fatigue, chest pain, dyspnea, and fever. His symptoms started 3 days before the current presentation when he developed fever up to 38°C with shaking chills and malaise. His wife gave him paracetamol, and his fever resolved. During the next 2 days, he was feeling well, but on day of presentation, he again developed fever up to 38.5°C with shaking chills, but this time he also has epigastric pain, dyspnea, mild chest pain, and extreme fatigue. On exam, the patient is alert, but somnolent, with slow thinking (bradypsychic), rarely responding to the answers, hypotensive (60/40 mmHg), subfebrile (37.8°C), slightly tachypneic (RR: 24/min), tachycardia (HR: 143/min), hypoxic (SpO2: 66% on room air, 87% on 2L/min of O2), with cyanotic lips, with distended neck veins. Auscultation of the heart revealed normal heart sounds with tachycardia, and auscultation of the lung was unremarkable. What is your thinking of this case? How would you approach and what would be your further diagnostic and therapeutic management steps?

2 Likes

LikeAnswersShare
Rotation. Tracheal deviation towards left. Left basal heziness seen. ? Thickening of pericardium/ pneumopericardium ?? Giant central hiatus hernia. Adv Echo CD and CT thorax.
Cardiomegaly with consolidation suggestive of COVID 19 Infection. Treat pt as per protocols. Needs further investigation and evaluation to conclude.
Thanks Dr Sandeep Ghodekar
0

View 3 other replies

The patient should get admitted in the isolated ICU with ventilation may be covid19 with cardiomyopathy with hyperinflated lung in my opinion
Copd emphysema cardiomyopathy hypotension 2decho hrct expiratory films
SUGGESTIVE of GIANT CENTRAL. HIATUS. HERNIA DD PNEUMOPERICARDIUM.
I agree with Dr Sandeep Ghodekar
cardiomegaly consolidation of right lower lobe emphysema need to rule out covid 19 pcr test ecg lung function test
WIDENING OF MEDIASTINUM WITH BOWELS IN THE MEDIASTINUM SEEN. THIS IS A CASE OF HIATUS HERNIA. NO COVID 19
Agreed with Dr.Sandeep G .Needs Cardiothoracic sirgeon’s consultation
Admit in ICU. Covid 19 to be ruled out.
Load more answers

Cases that would interest you