28 y/o, female chief complaint: dyspnea 3 days pta underwent dental procedures 2 days pta...
TRANSCRIPT
![Page 1: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/1.jpg)
CASE 2: RHEUMATIC HEART DISEASE
![Page 2: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/2.jpg)
28 y/o, Female Chief Complaint: Dyspnea
![Page 3: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/3.jpg)
3 days PTA • Underwent dental procedures
2 days PTA •Productive cough with yellowish sputum accompanied by colds•Pricking chest pain radiating to the back lasting for more than 30 mins accuring even at rest•Fever T 38 0C , joint pain and myalgia
1 day PTA •Increase severity of symptoms with accompanying dyspnea and easy fatigability
History of Present Illness
![Page 4: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/4.jpg)
(+) frequent streptococcal throat infection in childhood
At age 6- Valvular heart disease w/ monthly injections of Benzathine Penicillin
Past Medical History
![Page 5: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/5.jpg)
(+) HPN- grandfather (+) Heart disease- father
Family History
![Page 6: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/6.jpg)
Drowsy, in respiratory distress, prefers the semi sitting position
BP-130/60 PR-124bpm CR- 135bpm,irregulary irregular
RR- 40cpm T 38.50C Cold, clammy extremities, no active
dermatoses No nasoaural discharge with alar flaring Moist buccal mucosa, hyperemic posterior
pharyngeal wall, tonsils not enlarged
Physical Examination
![Page 7: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/7.jpg)
Supple neck, distended neck veins at 4-5cm at 30 0 angle
Symmetrical chest expansion, (+) supraclavicular retractions, coarse crackles over both lung fields
Dynamic precordium, AB at 6th LICS AAL, (+) heave at L lower parasternal area, (++) impulse at the 2nd LICS
Apex: S1 vary in intensity, grade 3/6 holosystolic murmur radiating to the axilla; Normal S2, opening snap and grade 3/6 diastolic rumbling murmur
Base: pulmonic component of S2 is loud grade 3/6 diastolic blowing murmur
Physical Examination
![Page 8: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/8.jpg)
Globular abdomen, liver is palpable Extremity: Grade 2 bipedal edema
Physical Examination
![Page 9: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/9.jpg)
Dyspnea Underwent dental procedure Productive cough with yellowish sputum
accompanied by colds Pricking chest pain radiating to the back lasting
for more than 30 mins accuring even at rest Fever, joint pain and myalgia (+) frequent streptococcal throat infection in
childhood At age 6- Valvular heart disease w/ monthly
injections of Benzathine Penicillin
Salient Features
![Page 10: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/10.jpg)
FH: (+) HPN- grandfather, (+) Heart disease- father
PE findings: drowsy, in respiratory distress, prefers the semi sitting position
BP-130/60 PR-124bpm CR- 135bpm,irreg RR- 40cpm T 38.50C Cold, clammy extremities hyperemic posterior pharyngeal wall, tonsils
not enlarged
Salient Features
![Page 11: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/11.jpg)
distended neck veins at 4-5cm at 30 0 angle Symmetrical chest expansion, (+) supraclavicular
retractions, coarse crackles over both lung fields Dynamic precordium, AB at 6th LICS AAL, (+)
heave at L lower parasternal area, (++) impulse at the 2nd LICS
Apex: S1 vary in intensity, grade 3/6 holosystolic murmur radiating to the axilla; Normal S2, opening snap and grade 3/6 diastolic rumbling murmur
Base: pulmonic component of S2 is loud grade 3/6 diastolic blowing murmur
Salient Features
![Page 12: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/12.jpg)
Palpable liver Grade 2 bipedal edema
Salient Features
![Page 13: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/13.jpg)
CBC
Hgb- 120 N ESR - >100mm/hr ↑
Hct- 40 N ASO- >200IU/L ↑
Plt- 305 N
WBC-19.9 x109/L ↑
Seg-0.91 ↑
Lympho-0.08 ↓
Laboratory Tests
![Page 14: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/14.jpg)
Cardiomegaly with features of mitral valve pathology
Pulmonary edema
Haziness at the R paracardiac border
Chest X-ray
![Page 15: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/15.jpg)
Atrial Fibrillation with rapid ventricular response
Non specific ST-T wave changes
ECG
Go back to ECG homepage
![Page 16: 28 y/o, Female Chief Complaint: Dyspnea 3 days PTA Underwent dental procedures 2 days PTA Productive cough with yellowish sputum accompanied by colds](https://reader036.vdocuments.mx/reader036/viewer/2022083005/56649f0e5503460f94c22ddd/html5/thumbnails/16.jpg)
Mitral Stenosis, moderate to severe Mitral Regurgitation, moderate Aortic Regurgitation, moderate LV and RV dilatation Dilated LA and RA w/ no evidence of
thrombus Dilated main pulmonary artery
2D Echo