25 year old woman with shortness of breath.

September 06, 2020
Hello everyone.. I am Sai Niharika , an intern posted in medicine department and one of the important terms of getting the internship completion is to complete my log book with my online log of what I learn during the course of my duties.

Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.

This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome

Here is the case I have seen-


A 25 yr old woman presented to our hospital at around 6pm with chief complaints of cracked nipples since 7 days. breathlessness and profuse sweating since 3 days, vomitings since morning.

She was apparently well 7 days back,then had cracking of nipples a/w pain and profuse sweating and breathlessness since 3 days,sob is sudden in onset and progressed from grade 1-4. Sweating n sob increases after breast feeding her baby.H/O 5 episodes of loose stools 4 days back.she underwent LSCS 45 days back and c/o bleeding PV since 45 days.

No past h/o of HTN, DM, COPD,TB, epilepsy, jaundice ,CHD, CKD

General physical examination:

Pt is conscious coherent and cooperative

Moderately built and nourished

Afebrile, BP 140/110mmhg --- 120/90mmhg now

PR 122bpm.  

RR 34 cpm

spO2 100% with 2 Lt of O2


Systemic examimation:

CVS- S1 S2 heard loud p2, JVP elevated (collapsing type).

RS- BLAE present,NVBS,no crepts 

P/A : Soft,tenderness present at suture si

CNS - Higher mental functions normal

Motor system- intact

Sensory system - intact

Cranial nerve examination- normal 

Investigations :


LFT DAY 1:

LFT DAY 2:




2D echo - MR, TR present,dilated cardiac chambers,pericardial effusion present.

USG Abdomen - mild ascites present.
USG bilateral breasts -

Minimal to mild retroareolar inflammatory changes with localised fluid collection.

B/l prominent ducts secondary to post partum

Diagnosis:

Postpartum cardiomyopathy with sepsis with anemia with chronic blood loss.


Treatment

1 unit of pRBC transfused at 12 am.

Inj piptaz 4.5 gm IV BD

Inj lasix 40 mg iv TID

Tab Orofer xt BD

Tab neurobion forte OD

Tab telma 40 mg OD at 9am

Tab spironolactone 25 mg OD at 8 pm

Continuous ecg monitoring

Temp PR charting 4th hourly

Bp charting hourly strict I/o charting.

Tab.Metronidazole 500 mg TID

Inj optineuron  1 amp in 500ml NS over 4 to 5 hours

Fluid restriction up to 1.2 lit/day

Tab PCM 650 mg sos.


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