2. Name - Mrs. Nazma Begum
Age -55years
Sex -Female
Occupation - Housewife
Marital status - Married
Religion - Islam
Address – kapasia, Gazipur
Date of admission - 22/7/2017 through OPD
Date of Examination - 27/07/2017
Cardiology DMCH
3. Breathlessness for 15 days
Cough with mucoid expectoration for 20 days
Palpitation for 5 months
Weakness and easy fatiguability for 5 months
Cardiology DMCH
4. According to the statement of the patient , she was
reasonably well 5months back. Then she
mentioned about few episodes of intermittent
palpitation which are short lived, more on
moderate to severe exertion, relieved by taking
rest, not associated with chest pain, light-
headedness, any episode of unconsciousness or
polyuria, but associated with weakness and
fatiguability
Cardiology DMCH
5. Patient also complains about progressively
increasing difficulty in breathing on moderate to
severe exertion for last 20 days which is associated
with nocturnal breathlessness at late hours of night
for she has to get up from sleep, but gives no h/o
breathlessness on lying flat, bluish discoloration of
skin ( exertional) and sweating.
Cardiology, DMCH
6. She complains of cough with expectoration of
mucoid sputum, but no hemoptysis or wheeze, not
aggravated by exposure to cold, dust, fume and no
seasonal variation.
There is no history of chest pain, joint pain,
abdominal swelling, loss of consciousness,
jaundice. Her bowel and bladder habbit is normal.
Cardiology DMCH
8. She has two sons and one daughter. All are
enjoying good health.
Parents are not alive. Her brothers and sisters are
also free from any significant/relevant illness.
No such illness runs in her family
Cardiology DMCH
9. She belongs to a low socio-economic family.
She lives in pucca house, drinks arsenic-free
tubewell water and uses sanitary latrine.
Cardiology DMCH
10. She is in post- menopausal age
Immunization History
She was not immunized as per EPI schedule
Cardiology DMCH
12. Pulse: 105beats/min, regular in rythm, no radio
radial and radio femoral delay
BP: 100/70 mm of Hg on both upper limbs
Respiratory rate: 29 breaths/min
Temp: 99 degree farenheit
JVP: raised
Cardiology DMCH
13. Pulse:
105beats/min (HR-107/min), normal volume, regular in
rythm
No radio radial and radio femoral delay
Condition of vessel wall normal
All the peripheral pulses are normal
Precordium :
Inspection:
No visible apical impulse
No epigastric pulsation.
No scar mark or bony deformity.
Cardiology DMCH
14. Palpation:-
Apex beat is left 5th intercostal space, 9cm from midsternal
line, just medial to midclavicular line, thursting in nature
Thrill:- Absent
Palpable P2 in pulmonary area
Left parasternal heave present
No epigastric pulsation
Cardiology DMCH
15. 1st heard sound is normal in all areas
Wide, fixed splitting of 2nd heart sound with loud
P2
There is an ejection systolic murmur in the left 2nd
and 3rd intercostal space with no radiation and
grading of the murmur was 2/6.
There is also high pitched mid diastolic murmur in
tricuspid area.
Bilateral basal crepitations present.
Cardiology DMCH
19. In pulmonary stenosis-
silent precordium, apperant no pulsation
Thrill may be present in pulmonary area
Soft or absent P2
wide splitting 2nd heart sound present but not
fixed
ESM present, intensity increase with inspiration,
may radiate to neck
Cardiology DMCH
20. PAPVC-
Second heart sound widely split, but not fixed
ESM both sides of sternal border
VSD-
Systolic thrill over left lower parasternal area
Pansystolic murmur in left lower parasternal area
Cardiology DMCH
30. Bed rest
Propped up position
High flow oxygen inhalation
Diuretic- frusemide I/V
Spironolactone
ACE inhibitor
Digoxin
Cardiology DMCH
31. Cardiac catheterization
Large ASD – surgical or device closure should
be done ( if pulmonary flow to systemic flow
2:1 or more)
If complication develop- (e.g Eisenmenger’s
syndrome) ,surgery is contraindicated.
Cardiology DMCH
