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.

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Must do vivid 19 rtpcr thyroid function and rft. Cautious use of diuretics , oxygenation and treatment for asthma ..

treat the main presenting ailment , hypothyroidism has its manifestation with cardiac anomalies too, would prefer to treat the hypothyroidism and then go for other differential diagnosis of cardiopulmonary complications ,
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To add Thyroxine 75 mcg od in this case

PHTN with B/V failure Treatment:- 1. Sacubitril + Valsartan..100 mg bd 2.Torsemide....10 mg.od 3.Formeterol + Budesonide inhaler 2 puffs bd 4.Pantoprazole 40 mg od 5.Salt & fluid restriction 6.Influenza & Pneumococcal vaccination annually in the months of September/or October (Prophylactic)

Hypothyroidism Copd Severe PAH ( Primary) Compromised LVSF Rx 1 Elequis 2 viagra 25 mg BD Metoprolpl ARB Diuretic Salt fluid restrictions Formoterol + Budisonide inhaler Vaccine pneumonia influence covid 19 There is possiblity sudden Tachyarrhythmoa prophylactic = Amiodarone 02 inhalation

Prophylactic.. = Amiodarone
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Biventricular cardiomegaly. Adv. Cardiac workout.

Thanks,Dr.Dinesh Gupta.
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46yrs old patient is known case of branchial asthma presenting with features of CHF ,there is no prominence of pulmonary conus in her x-ray chest PA view and no features of RVH in her ECG .In my view it is case of branchial ashtha with hypothyroidism with ischaemic cardiomyopathy with multiple VPCs with CHF .VPCs are precipitating factor for CHF and should be treated accordingly. Although primary PAH is common in female in which lung fields are olegaemic.

POSSIBLY ??? CONGESTIVE HEART FAILURE

Hypothyroidism ; Bronchial astma, Myocardiopathy with biventricular hypertrophy. MANAGEMENT; Tab pulmoclear, Diuretcs dytor 10mg bd Metoprolol 150mg.od at ngt. Salt fluid restriction..

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Known C O hypothyroidism with bronchial asthma 2deco suggest myocardiopathy Biventricular hypertrophy with dialated atria b/l I've and apical hypokinesia Pulmonary vessels are dialated with basal congestion suggest PAH Pt has multiple comorbidies as poor PFT bcz Crh bronchial asthma PAH & myocardiopathy leading to CHF Hence pt has pedal oedema and SOB Beside duolin budecort inhalation Tab pulmoclear Diuretics dytor10mg bd Monitoring spO2 Consider inj pentoxyphyline for PAH

Boseton for pulmonary hypertension
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