patient has came health check up::and complain of tiredness,since his childhood when he ran during the pt or sports he tired before than his peers.sometimes he complain at wheezing sound during his breathing especially when he lie on bed,and added he a@dded he used cough after taking lunch or dinner regularly,no htn wt 84 kg other hematology biochemistry xray (usg: hepatomegaly with grade 1 fatty liver) others report are normal. what should the line of councelling

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1 PFT 25(OH) D HEPATITIS VIRAL PROFILE 2 H/O TOBACCO ,ALCOHOL ? 3 WT REDUCTION 4 SMALL FOOD AT A TIME 5 DINNER-------------------TO BED 3--4 HRS GAP 6 HD END OF BED SLIGHTLY RAISED 7WALKING 30----40 MTS / DAY 7 STOP ADDICTIONS IF ANY 8 ADDI D VITAMIN IF LOW (FATTY LIVER)

SR, IRBB, LAD 30 deg,Criteria not fitting ? Obesity.IRBB may be normal. Look for LV diastolic dysfunction. , PH,, HTN, dyslipidemia

Sir his weight is 84 kg, bp was 132-80 lipid profile lft kft cbc was close to normal.eosiphil count was -8only sir echo report has been attached too kindly take a look sir @Dr. Mallesh Kariyappa thank you for response.looking forward too
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Exercise induced Bronchial Asthma. Do spirometery and Nebulise withSalbutamoland see effect

Sir he told his history of childhood,now he don't use bike or motorbike, conviently use his foot.thank you sir for your suggestion @dr. Prakash jain @dr Prakash jain
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Obstructive sleep apnea? Check air flow, blood oxygen level, muscle activity, sleep pattern, throat examination

Will mention others finding??
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Of course , also for obstructive sleep apnea evaluation.

Diastolic function in Echo surpringly normal for this weight.please look back the history of origin of sound at Nasal, oropharyngeal, bronchus, increased abdominal pressure. Sleep patterns, any complaints from co sleepers,

Epsilon wave in v1 look for Arrhythmogenic rvdysplasia

V1 show Epsilon wave ARVD should be ruled out CMRI is choice

Please ask the echo cardiogram her to look for DT,E/A,IVRT,IVCT, PA ACCT,RVET AND RSTIO. I DO AGREE WITH DD OF OSA. I THINK POLYSOMNOGRAPGHY WOULD REVEAL

Obesity &Br Asthma .

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