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.

62 year female was admit in govt hospital 8 days back with diagnosis of dvt rt leg and thrombus in ivc. Pt came to with c/o dyspnea, cough from three days and blood in sputum from one day. On examination bp was 140/90, b/l crepts, clubbing was present. Pt was o2 dependent and spo2 was 70 %, with o2 it was 94%. Investigations are as below Expert opinions are welcomed Update 1 : 2DECHO -severe pulmonary artery hypertension -Dialeted RA RV -thrombus in IVC -LVEF 55%

F40. Pain chest off and on..2months HTN...0,DM.....0.

80 yrs chulha smoker female, known copd ,off treatment since a year, presented with cough fever and dyspnea since last 5 days. HR 110, BP 140/100, spo2 50%. taken on NIV. RS-bil polyphonic wheezing with tachypnea. reports are attached. plz discuss approach to the case.

A 75 year old obese male was admitted to the ICU with fever 38.2°C, retrosternal pain and progressive dyspnea. The patient had distended jugular veins, paradoxical pulse wheezes and bowel sounds at the left hemithorax during auscultation. At the time of admission the ECG showed signs of left ventricular hypertrophy. What is the diagnosis from chest x ray. and explain about treatment plan.