CASE 2.

ET, 11 year old female from Masbate was admitted for dyspnea.

Prenatal/Natal History:Patient was delivered full term via normal spontaneous delivery by a 20 year old,
G6P6(6006) mother. Prenatal check-ups started at 4 months AOG. No maternal illnesses as claimed.
Patient was bottlefed since birth. Mother cannot recall the dilution of milk.

Postnatal History:
Patient received his complete primary immunizations at their local health center with no booster doses.
Developmental milestones are at par with age. No previous hospitalizations.
Patient had recurrent episodes of odynophagia but self-medicated with saline gargle and provided relief.

History of Present Illness:

2 years PTA, patient had palpitation and easy fatiguability. She was admitted in a local hospital for 5
days where laboratory examinations were done. Parents were not informed about her diagnosis.
However, she was given several medications including intravenous drugs and she was discharged
improved. Home medications were only given for one month. She was able to resume normal activities
and schooling.
1 month PTA, she had low grade fever and started to develop easy fatigability and orthopnea which
forced her to stop schooling. She also had poor appetite, weight loss and decreased urine output.
10 days PTA, patient was hospitalized. However, with no improvement after 4 days, parents decided to
bring her home. Worsening of her condition prompted parents to bring the patient to Philippine General
Hospital.
Physical Examination:
Wheel-chair bound, in cardio-respiratory distress
Weight: 21kg BP: 90/60 HR: 131/min RR: 34/min T=37.7C
Skin/HEENT: sallow, pink conjunctivae, no alar flaring, no periorbital edema
Chest/lungs: equal chest expansion, harsh bronchovesicular breath sounds, no rales, no wheezes
CVS: dynamic precordium, left precordial bulge, (+) heave, (-) thrill, distinct heart sounds, tachycardic,
irregular rhythm, soft, short grade 2 systolic murmur at the apex with radiation to the axillae, soft,
systolic murmur at the left lower sternal border
Abdomen: globular, (+) liver edge palpable 5cm beneath right subcostal margin, (-)fluid wave
Extremities: pulses fair , nailbeds are pink, grade 2 bipedal edema
GUT: grossly female
LABORATORY RESULTS
CBC with platelet count: hgB: 8.3mg/dL
Hct: 24.9 mg/dL
WBC: 8.2
Segs: 35 mono: 3
Lympho: 65 eosino: 1
Platelets: 305, 000

12-L ECG