SEVERE LV DISFUNCTION

SIR,
  MY FATHER AGE IS 57,AND HE GOT HEART STROKE.DOCTOR DIAGNOSIS THAT.. ACUTE DECOMPENSATED HEART FAILURE,NSAID INDUCED,CORONORY ARTERY DISEASE,SEVERE LV DISFUNCTION.

THIS IS ON 25-01-2010

PATIENT IS CONSCIOUS/COHERENT/AFEBRILE/NOICTERUS/CLUBBING/PALLOR/PEDAL EDEMA

PR :142/MIN      BP:120/90mmHg
HEART : S1+,S2+     LUNGS: C1 CLEAR    CNS :NAD        RR:18/min       JVP :NORMAL       P/A :Soft,BS+

HE KNOWN CAD,OLD AWMI(2006) S/P UROKIKANE S/P CAG--RECONALISED LAD AND SEVERE LV DISFUNCTION ON MEDICAL MANAGEMENT REFERED HERE FROM WARANGAL ASA A CASE OF ACUTE LVF FOR FURTHER MANAGEMENT.C/O SEVERE SOB AND DRY COUGH.NO H/O DM/HTN/APD/TIA/CVA/COPD/Br.ASTHAMA/BLEEDINGDIATHESIS/DRUG ALLERGY.PRESENT HE IS USING MEDICINES...

LASIX 40 MG
PLANEP 25 MG 1/2 TAB
ISMO  20 MG
COPITAB A  75 MG
ATOCOR 20 MG
RAMIPRIL 1.25 MG
CARDIVAS 3.125MG
DIGOXINE .25MG
IVABRID 5MG
FLAVEDON MR 35 MG

LAB INVESTIGATION:
BLOOD SUGAR RANDOM: 91mg/dl      MCH    32.8 p/gms
BLOOD UREA      :             33 mg/dl     MCHC   35.9 %
SERUM CREATININE :       1.4 mg/dl      W.B.C COUNT  7,700 CELL
SERUM SODIUM  :           141mEq/L         NEUTROPHOLS    66%
SERUM POTASSIUM  :   3.5 mEq/L            LYMPHOCYTES             29%
HAEMOGLOBIN       :        14.6  gms%        EOSINOPHILS        05%
P C V                             40  VOL %            PLATELECOUNT 3.39 LAKHS
R B C COUNT              :    4.4 mill/c               E.S.R    05 mm/hr
M C V                    :           91.5 cubic           PHERIPHERAL  SMEAR          RBC :NORMC

OTHER INVESTGATION   2D ECHO:

LA/LV DILATED
LV REGIONAL WALL MOTION ABNORMALITY+
MID DISTAL  IVS, APEX ,APICOANTERIOR WALL THINNED AKINETIC
HYPOKINESIA OF OTHER SEGMENTS
SERVERE L V SYSTOLIC DYSFUNCTION,EF = 18%
GRADE III LV DIASTOLIC DYSFUNCTION
LOW MODERATE MR
MILD TR,NORMAL RVST
NORMAL RV FUNCTION
NOPERICARDIAL EFFUSION /CLOT

CORSE IN HOSPITAL
HE EVALUATED FOR ABOVE MENTIONED HISTORY FOUND TO HAVE CCF WHICH WAS TRAETED WITH IV DIURETICS AND OTHER ROUTINE MEDICATIONS .HE IMPROVED SYMPTOMATICALLY AND GOT DISCHARGE IN A STABLE CONDITION WITH THE ADVICE OF REGULAR MEDICATION AND FALLOW UP .HE WAS ADVISED THE NEED FOR AICD AND/OR HEART TRANS PLANTATION.

FOLLOW UP :

REVIEW IN OPD ON 12 -02-2010  WITH PRIOR APPOINTMENT.

SO PLEASE GUIDE TO US THAT IF ANY NECESSARY OF HEART TRANSPLANTATION OR NOT.

THANK YOU ..

YOURS FAITH FULLY

PAVAN KUMAR C

[pavvi007]

SIR,
  MY FATHER AGE IS 57,AND HE GOT HEART STROKE.DOCTOR DIAGNOSIS THAT.. ACUTE DECOMPENSATED HEART FAILURE,NSAID INDUCED,CORONORY ARTERY DISEASE,SEVERE LV DISFUNCTION.

THIS IS ON 25-01-2010

PATIENT IS CONSCIOUS/COHERENT/AFEBRILE/NOICTERUS/CLUBBING/PALLOR/PEDAL EDEMA

PR :142/MIN      BP:120/90mmHg
HEART : S1+,S2+     LUNGS: C1 CLEAR    CNS :NAD        RR:18/min       JVP :NORMAL       P/A :Soft,BS+

HE KNOWN CAD,OLD AWMI(2006) S/P UROKIKANE S/P CAG--RECONALISED LAD AND SEVERE LV DISFUNCTION ON MEDICAL MANAGEMENT REFERED HERE FROM WARANGAL ASA A CASE OF ACUTE LVF FOR FURTHER MANAGEMENT.C/O SEVERE SOB AND DRY COUGH.NO H/O DM/HTN/APD/TIA/CVA/COPD/Br.ASTHAMA/BLEEDINGDIATHESIS/DRUG ALLERGY.PRESENT HE IS USING MEDICINES...

LASIX 40 MG
PLANEP 25 MG 1/2 TAB
ISMO  20 MG
COPITAB A  75 MG
ATOCOR 20 MG
RAMIPRIL 1.25 MG
CARDIVAS 3.125MG
DIGOXINE .25MG
IVABRID 5MG
FLAVEDON MR 35 MG

LAB INVESTIGATION:
BLOOD SUGAR RANDOM: 91mg/dl      MCH    32.8 p/gms
BLOOD UREA      :             33 mg/dl     MCHC   35.9 %
SERUM CREATININE :       1.4 mg/dl      W.B.C COUNT  7,700 CELL
SERUM SODIUM  :           141mEq/L         NEUTROPHOLS    66%
SERUM POTASSIUM  :   3.5 mEq/L            LYMPHOCYTES             29%
HAEMOGLOBIN       :        14.6  gms%        EOSINOPHILS        05%
P C V                             40  VOL %            PLATELECOUNT 3.39 LAKHS
R B C COUNT              :    4.4 mill/c               E.S.R    05 mm/hr
M C V                    :           91.5 cubic           PHERIPHERAL  SMEAR          RBC :NORMC

OTHER INVESTGATION   2D ECHO:

LA/LV DILATED
LV REGIONAL WALL MOTION ABNORMALITY+
MID DISTAL  IVS, APEX ,APICOANTERIOR WALL THINNED AKINETIC
HYPOKINESIA OF OTHER SEGMENTS
SERVERE L V SYSTOLIC DYSFUNCTION,EF = 18%
GRADE III LV DIASTOLIC DYSFUNCTION
LOW MODERATE MR
MILD TR,NORMAL RVST
NORMAL RV FUNCTION
NOPERICARDIAL EFFUSION /CLOT

CORSE IN HOSPITAL
HE EVALUATED FOR ABOVE MENTIONED HISTORY FOUND TO HAVE CCF WHICH WAS TRAETED WITH IV DIURETICS AND OTHER ROUTINE MEDICATIONS .HE IMPROVED SYMPTOMATICALLY AND GOT DISCHARGE IN A STABLE CONDITION WITH THE ADVICE OF REGULAR MEDICATION AND FALLOW UP .HE WAS ADVISED THE NEED FOR AICD AND/OR HEART TRANS PLANTATION.

FOLLOW UP :

REVIEW IN OPD ON 12 -02-2010  WITH PRIOR APPOINTMENT.

SO PLEASE GUIDE TO US THAT IF ANY NECESSARY OF HEART TRANSPLANTATION OR NOT.

THANK YOU ..

YOURS FAITH FULLY

PAVAN KUMAR C