Concluded Case

Effusive COVID 19

29 year old female presented with history of high grade fever since last 4 days. She also dyspnoea on exertion n gabhrahat. Her systemic examination is unremarkable. BP was 90 systolic Tamp 99 Pulse 120/min RR was 24/min Her blood investigations revealed Leukocytosis (WBC 14000) Normal platelets Normal N/L ratio CRP 116 Other investigations including LFT n urine routine as well as MP by smear & Pf, Pv antigen were negative. Her ECG & X ray chest are as followed.. Kindly discuss differential diagnosis n further management.

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Concluded answer

PERICARDIAL & PLEURAL EFFUSION TURNED COVID 19 POSITIVE. PROBABLY EFFUSIVE COVID.. A UNIQUE PRESENTATION OF COVID 19..

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Cardiomegaly Straightening of left heart border ? Valvular heart disease, ? Pericardial effusion. ECG Sinus tachycardia, low voltage complexes Poor progression of R in V1 to V3. Suggestive of dilated cardiomyopathy, Pericardial effusion Blood counts and CRP in favour of acute infection. Blood culture, RTPCR for COVID. ECHO . Cardiac enzymes, Ferritin, LDH

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Water bottle cardiac shadow Cardiomegaly with PERICARDIAL EFFUSION Ecg suggest sinus tachycardia Low voltage tracing Low systolic bp high temperature Positive crp Lt costophrenic angle is obscured as cardiomegaly and minimal effusion D/d Rheumatic cardiac disease 2 tubercular pericarditis

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Cxray shows cardiomegaly and hyperinflation. ECG NSR tachycardia Left axis deviation. Low voltage complex. Findings favours pericardial effusion / DCM Adv 2d Echo CD. Blood culture. ESR ASO TFT Routine lab investigation.

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X ray chest shows cardiomegaly and ECG shows low voltage ECG - Low voltage on the ECG is defined as a peak-to-peak QRS amplitude of less than 5 millimeters in the limb leads and/or less than 10 millimeters in the precordial leads. These finding indicates sage is having pericardial effusion Adv Urgent 2 D ECHO High WBC count indicate bacterial infection, USG abdomen to be done to look for intraabdominal cause of infection

* CXR .. CARDIOMEGALY.. * ECG .. SINUS TACHYCARDIA.. * LEUKOCYTOSIS.. SUGGESTIVE OF.. INFECTION .. ? PNEUMONIA .. ? COVID-19 .. ? MYOCARDITIS .. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH.. IGg .. IGm .. DENGUE TEST.. 2D ECHO STUDY.. MANAGEMENT AS PER PROTOCOLS.. BY.. ICMR..FOR.. COVID-19..

X ray reveals cardiomeagaly. Ecg sinus tachycardia. TLC raised.looks like viral pneumonitis with myocarditis. Pl go for cardiac enzymes. 2d echo. Covid test.pl get her dengue .Ns1 and antibodies igg/ igm. Pl start with antibiotics paracetamol iv fluids. Pl have a watch on O2 saturation

Cardiomegaly lt basal pneumonia some parenchymal tissue seen sinus tachycardia q wave in lead 3 t wave inverted in3&v1 low volume ecg in favor of pericardial effusion covid era hrct 2d echo rt pcr sarscov2 do it leucocytosis

X Ray chest show cardiomegaly ECG wnl Tlc count increase show infection Advice 2 d echo Covid test Give Symptomatic treatment

@@Dr. Viral Patel its seems just cardiomegaly with clinically ccf will confirm through LVEF BY 2D ECHO

PERICARDIAL & PLEURAL EFFUSION TURNED COVID 19 POSITIVE. PROBABLY EFFUSIVE COVID.. A UNIQUE PRESENTATION OF COVID 19..

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