| 63 years old obese,ex smoker Muslim patient residing at moyna,midnapore,west Bengal was admitted at our institute on 9th june 2009 with complaint of shortness of breath & chest pain on exertion for 2 months,abdominal distension for 3 months & difficulty in passing urine for the same duration.On detailed enquiry chest pain was precordial ,non radiating ,non progressive in nature not relieved on rest or medications.Shortness of breath was associated for the same duration on exertion.Abdominal distension was noticed by family members during that period.Patient consulted local doctor for the difficulty in micturition for which he was catheterized & advised some investigations.No signicant history of syncope, palpitation, paroxysmal nocturnal dyspnea was there.Significant past history included enteric fever in childhood & acute arthritis 5 years back for which patient was treated conservatively.Significant family history included H/O IHD in elder brother.he was known hypertensive for last 6 years on medication.
On admission patient was clinically examined.Findings were as follows:
Pallor+, icterus–,cyanosis–,clubbing–,bilateral pedal edema++,b.p-120/80mmHg,pulse – 84/min,regular,afebrile,no local swelling,deformity,tenderness.
GI system-soft non tender,mild hepatomegaly(4 cm below costal margin).no other organomegaly,mild ascitis(fluid trill absent,fluid shift present),no herniation.
CV system- apex in the 5th ICS in MCL,s1,s2-audible,soft diastolic murmur(2/6) with no accentuation heard at mitral area with no parasternal heave,thrill.all peripheral pulses were palpable and were equal on both sides.
Respiratory system- air entry equal on both sides,b/l vesicular sounds present,no adventitious sounds,trachea in midline.
CNS-patient was conscious.cooperative,coherent.all superficial & deep reflexes were present.bowel habit was normal.patient was admitted with no.14 folley’s catheter in situ
Questions:-
1) What would the next investigations you carry out
2) What is your most likely diagnosis |
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