Problem solving 13/09/21 - 01

 



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Picture of the day - An elderly lady with shortness of breath

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A 62 years old lady presented with a history of shortness of breath for 2 years. She denied cough or wheezing. There was no history of ischemic chest pain in the past. Family history was unremarkable. On examination she was tachycardic. Blood pressure was 110/80mmHg. The house officer could not detect a murmur. Lungs were clear. In view of the cardiomegaly on the Xray, the house officer started IV frusemide and aspirin. The next day during the ward round, the consultant asked the HO to re-auscultate the patient. What is the diagnosis?
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ECG's - Things you might miss

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A 52 years old man presented with central chest pain for one-hour duration. He admitted that he had on and off chest pain on exertion for the last few months. Picture from internet House-officer noted the ST depressions and gave S/L GTN, Aspirin 300mg, Clopidogrel 300mg, and atorvastatin 40mg stat doses. The ECG was 'vibered' to SHO and on his approval, HO started S/C enoxaparin 60mg bd. The next morning when the ECG was shown to the consultant, his eyebrows rose! 'You should've sent me the ECG.' He said. What would you have done if this patient came to you?? Whenever you see an ECG of a patient coming with chest pain, your priority should be to look for the presence of any evidence of STEMI, STEMI equivalents or other ECG changes that warrant immediate intervention. This is one such ECG. As you can see there are ST-segment depressions in many chest leads. In such instances make it a habit to look at aVR and V1 leads.  According to ESC guideli...
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2 min read - Pneumonia

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A 75 years old female patient with diabetes mellitus, hypertension and ischemic heart disease presented with fever and cough for 3 days duration. She produced yellow color sputum, but there was no hemoptysis. There was right-sided chest pain on breathing. She had nausea and the appetite was poor. What are the possibilities? Fever, cough, sputum and pleuritic chest pain equals pneumonia unless proven otherwise! Many conditions can mimic pneumonia. Read and find out! On examination the patient was ill-looking. She was tachycardic and tachypnoeic. Blood pressure was 100/70mmHg.  Respiratory examination revealed signs localized to the right lower zone. Reduced chest expansion Increased vocal fremitus Dull percussion note Bronchial breathing Increased vocal resonance Whispering pectoriloquy! What do these physical signs mean?  Read about physical signs and how to interpret them. A consolidation in the right lower zone. With these findings, the clinic...
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