Cardiovascular system

Theme: Exertional dyspnea/chest pain

CBL Group B

Trigger 1

A 42 year old male comes to your clinic with difficulty in breathing, which he has
been feeling for past few days during his morning walk.

HOPC:

According to patient, for past 2 weeks he is having difficulty in breathing and

chest pain on doing any strenuous activity.

For one month, when he lies on bed to sleep at night, he experiences

breathlessness woke him up many times from sleep.

He sleeps with head elevated (with 2 pillows)

History of fatigue, weakness, faintness on and off for one month

Trigger 2

Vitals:

B/P: 160/40mm Hg

R/R: 27/minute

P/R: 110/minute

Large volume, collapsing pulse

Temperature:Afebrile

General Physical Examination:

Pallor, coldness of extremities is observed

Fine basal crepitations present

Bilateral pedal edema is noticed

JVP is raised

Systemic Examination:

CARDIOVASCULAR EXAMINATION:
Apex beat is displaced and heaving in character

S 1 normal

Early diastolic murmur is heard at left sternal edge, heard best while the patient is
leaning forward on deep expiration

S3 is heard

Systolic flow murmur is heard at left sternal border

RESPIRATORY:

Bilateral Crepitations heard

ABDOMINAL:

Liver is enlarged 2 cm below the costal margin

Trigger 3

What investigations would you suggest?

ECG
X-Ray chest
Echocardiography (Normal image with no structural abnormalities)
Echo image in this patient
Diagnosis: Aortic Regurgitation and CCF