DR Dibya

DEPARTMENT OF
CARDIOLOGY
MORNING SESSION
A 65 YEARS OLD MALE PRESENTED WITH

BREATHLESSNESS , PALPITATION ,CHEST
PAIN AND COUGH.
Presented By-
Dr. Dibya Jyoti Paul
Dr. Shaira Misbah
Date- 24/07/2023
Name: Azizul Islam
Age : 65 years
Sex : Male
Address: Gafargaon,Mymensingh
Religion : Islam
Particulars
Marital status: Married
User 5/26/2023
Bed No: 05 of the
Occupation: Farmer
Date of Admission : 15.04.2023

patient
Date of Examination : 15.04.2023
Ward No : 10 ; Bed no:05
Reg No : 27571
Presenting Complaints
1. Breathlessness for 2 weeks
2. Palpitation and cough for 5 days
3. Chest pain for 3 days
History of Present Illness
According to the statement of the patient he was
reasonably well few months back. However from the past
2 months, he has been suffering from
breathlessness .Initially he felt breathlessness during
moderate to severe exertion but for the past 2 weeks it
has been increasing progressively & hampering his day to
day activities. Breathlessness is not associated with
fume , dust, coal ,diurnal or seasonal variation.
Occasionally he experiences nocturnal dyspnea, usually
late hours of night. The patient also complaints of
palpitations even with mild exertion for the last 5 days
and also complaints of productive cough which is frothy in
nature, not associated with haemoptysis.
History of Present Illness(Cont…)
The patient also complaints of chest pain for 3

days which Is non radiating, Stabbing in nature
usually felt in the left sub-mammary region but
it is not associated with exertion &not relieved
by nitrates. He has no history of syncope. His
bladder and bowel habits are normal. With the
above complaints he got admitted into
CBMCHB for better management.
History of Past Illness
He had history of same type of attacks and he took
medication for this but cant remember the names.
He has no history of Diabetes and Hypertension
Family History .
All the family members enjoy good health.
History Drug
Took some drugs but can’t remember the names
Socioeconomic History
Lower middle class
Personal History
Smoker ,Non alcoholic and occasional betel nut chewer
Immunization History
Not immunized as per EPI schedule
GENERAL EXAMINATION
Appearance: Ill Looking
Body Built : Average
Co Operation : Co Operative
Decubitus : Propped Up
Anemia : Mild
Jaundice : Absent
Cyanosis : Absent
Clubbing: Absent
Koilonychia : Absent
Leukonychia : Absent
Oedema : Present(Pitting)
General examination
(continue..)
 Dehydration :No Dehydration
 Pulse : 94 bpm (Irregular)
 Blood Pressure : 120/70 mm of Hg
 Temperature : 98˚F
 Respiratory rate: 26 breaths per
minute
 Lymph nodes : Not palpable
 Thyroid Gland : Not enlarged
 Neck vein: Not Engorged
Cardiovascular Examination
Pulse: 94 bpm, rhythm is irregular, low volume

and character is normal in nature. No radio-radial
delay or radio-femoral delay. All peripheral pulses
are normal, condition of vessel wall is normal.
Blood pressure:130/90 mm of Hg
Jugular venous pressure: Raised.

Cardiovascular Examination
Inspection
Visible cardiac impulse on Mitral area.
Palpation
Apex beat is present in the left 6th intercostal
space, 10 cm away from the midline, diffuse,
thrusting in character.
Thrill: Present in left 6th intercostal space, systolic
in nature.
Cardiovascular Examination (Cont…)
Auscultation
First heart sound is soft in mitral area ,
normal in other areas.
Second heart sound is normal in all the
areas.
Murmur:- There is a pansystolic murmur
in mitral area, which radiates to the left
axilla and it is best heard on expiration
and reduced on inspiration.
Other system examinations
Respiratory System
Respiratory rate: 26 breaths / min

Breath sound : Vesicular
On auscultation: Bilateral Basal Creps
GIT System
No specific abnormality.
Other systemic examination reveals no
abnormality
Salient Features
Mr Azizul Islam a 65 years old
normotensive,nondiabetic,non alcoholic,smoker,muslim
farmer hailing from gafargaon, presented here with the
complaints of breathlessness. Initially he felt breathlessness
during moderate to severe exertion but for the past few
weeks it has been increasing progressively and hampering
his day to day activities and he sometimes feels
breathlessness while lying flat. . Breathlessness is not
associated with fume , dust, coal ,diurnal or seasonal
variation. Occasionally he experiences nocturnal dyspnea,
usually late hours of night. The patient also complains of
palpitations even with mild exertion.
Salient Features(Cont…)
He also complaints of cough which is frothy in nature but

not associated with haemoptysis.The patient also
complains about chest pain in the left sub mammary
region,which is Non radiating,stabbing in nature,not relived
by nitrates and not associated with exertion .He has no
history of syncope.His bladder and bowel habits are normal.
In his past medical history ,he had same types of attacks.
All his family members are in good health.
Salient Features ( Cont…)
On examination, He is ill looking,mildly anemic,

pitting oedema present but there are no signs of
clubbing
jaundice,cyanosis,koilonychia,leukonychia, and
dehydration. His blood pressure is 130/90 mm of
hg, Pulse 94 bpm , rhythm irregular, low volume
and character is normal.Jvp is raised. Respiratory
rate 26 breaths per minute with bilateral basal
crepitation.There is a visible cardiac impulse on
mitral area.
Salient Features ( Cont…)
Apex beat is present in the left 6th intercostal

space,10 cm away from the midline , diffuse and
thrusting in character.Thrill present in left 6th
ics,systolic in nature.
First heart sound is soft in mitral area,normal in
other areas. Second heart sound is normal in all
areas.There is a pansystolic murmur in mitral area
which radiates to left axilla and its best heard on
expiration and reduced on inspiration. Other system
reveals nothing abnormality
PROVISIONAL DIAGNOSIS
Mitral Regurgitation probably due to
Chronic Rheumatic Heart Disease with
Heart Failure
Differential Diagnosis
 Tricuspid Regurgitation with Heart failure

 Ventricular septal defect
INVESTIGATIONS
1. E.C.G
2. Echocardiogram (Colour Doppler)
3. Chest X-ray P/A view
4. Troponin I
5. Serum creatinine
6. Serum Electrolytes
Confirmatory Diagnosis
My confirmatory diagnosis is Mitral
Regurgitation due to Mitral Valve
Prolapse with Heart failure
Medical management:
Bed rest in propped up position
Oxygen inhalation
Diuretics : Frusemide
Treatment Vasodialator : Ace inhibitors

Palpitation : Beta blocker
Anticoagulant
Prophylactic penicillin : To prevent endocarditis
Follow up every 6 months by Echocardiogram
Surgical Treatment
 Valve replacement
28

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DEPARTMENT OF

A 65 YEARS OLD MALE PRESENTED WITH

Date of Admission : 15.04.2023

Ward No : 10 ; Bed no:05

The patient also complaints of chest pain for 3

Pulse: 94 bpm, rhythm is irregular, low volume

Jugular venous pressure: Raised.

Respiratory rate: 26 breaths / min

He also complaints of cough which is frothy in nature but

On examination, He is ill looking,mildly anemic,

Apex beat is present in the left 6th intercostal

 Tricuspid Regurgitation with Heart failure

Treatment Vasodialator : Ace inhibitors

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