Concluded Case

Right heart failure secondary to lung disease with severe PAH.

26yrs male presents with Breathlesness week since 1 weeks, diagnosed with severe PAH with AKI. No past H/o OSA,Connective tissue disorder,ECHO -WNL,ANA - Negative,Viral profile - Non reactive,HRCT Thorax - Consolidation RUL Cause and treatment??

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Concluded answer

Chest xray shows right atrial hypertrophy and right ventricular hypertrophy with right upper lobe consolidation. CTPA shows severe PAH with no obvious vascular cause. ABG reveals high anion gap metabolic acidosis with combined acute respiratory alkalosis with elevated lactate levels. Cause could be lactic acidosis seconday to bacterial pneumonia, renal failure(uremia) or uncontrolled DM(ketoacidosis). Echo shows congestive changes of right heart secondary to lung disease. Possibly case of Right heart failure secondary to lung disease with severe PAH, with uremia with right upper lobe bacterial pneumonia. Blood sugar, renal function and serum electrolytes, Blood culture and sputum culture need to be investigated. Usg abdomen to r/o congestive hepatomegaly and kidney size and echotexture. Rx Fluid resuscitation Respiratory support O2/NIV/Mechanical ventilation PRN IV betalactam+IV macrolide Diuretics Bronchodilators IV PDE-5 inhibitors Correct hyponatremia

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Chest xray shows right atrial hypertrophy and right ventricular hypertrophy with right upper lobe consolidation. CTPA shows severe PAH with no obvious vascular cause. ABG reveals high anion gap metabolic acidosis with combined acute respiratory alkalosis with elevated lactate levels. Cause could be lactic acidosis seconday to bacterial pneumonia, renal failure(uremia) or uncontrolled DM(ketoacidosis). Echo shows congestive changes of right heart secondary to lung disease. Possibly case of Right heart failure secondary to lung disease with severe PAH, with uremia with right upper lobe bacterial pneumonia. Blood sugar, renal function and serum electrolytes, Blood culture and sputum culture need to be investigated. Usg abdomen to r/o congestive hepatomegaly and kidney size and echotexture. Rx Fluid resuscitation Respiratory support O2/NIV/Mechanical ventilation PRN IV betalactam+IV macrolide Diuretics Bronchodilators IV PDE-5 inhibitors Correct hyponatremia

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He has dialated RA AND RV PAH Chest xray shows consolidation rt upper lobe ABG presents pt is in hyponatremia Metabolic acidosis Hypoxic Needs to be managed by 02 support niv or intubation Correct hyponatremia by iv inj NS or oral tab RESODIUM 10 MG 1OD broadspectrum antibiotics inj Ceftriaxozone or clerithromicin Bronchodilators Diuretics Constant monitoring

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Primary PULMONARY hypertension, since CT ANGIO does not show any PULMONARY arterial abnormality . ,nor is there a left to right shunt. No PE ? Cause of AKI DD Vasculitis causing PAH and Renal artery injury Goodposture Syndrome Bacterial/ Viral / fungal pneumonia in an immunocomromised individual

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It can be Bacterial Tubercular Suitable antibiotics after blood culture For t b MT Sputam for AFB CBNAAT If + ve then ATT

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A patch of pneumonitis right upper lobe. Left lungfield is clear. Cardiac shadow is enlarged with bulged pulmonary conus.

Pls give phospharas 30 & carbo veg 30