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    35years old man RECURRENT attake of palpitation

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    Dr.Maha
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    تاريخ التسجيل : 28/10/2008

    حصرى 35years old man RECURRENT attake of palpitation

    مُساهمة من طرف Dr.Maha في الثلاثاء 07 يوليو 2009, 6:05 pm



    35years old man not known case of any chronic diseases complain of recurrent attake of palpitation not related to his activity lasting for 30 to 45 min for 1year dyspnea progressively increased until interfere with his daily activity otherwise no history of PND ,chest pain or lower limbs swelling also no history of syncope
    no cough , whizz or hemoptysis
    systemaic reviw NAD
    past medical history NAD
    past surgical history NAD
    family history his mother is HPN
    social history single,not smoker ,not alcoholic

    on examinations
    pt. consious orinated not dyspnic not ortopanic no pallor no yellowish discolourations of sclera
    BP;11O\70
    PR:92 BPM irregularly irregular
    HR:98 BPM
    TEMP :36.5
    RR:22 cycle\min
    jvp; not raised
    L.L.O: -VE
    NO lymphadenopathy
    CHEST : equal air entry bilateral , NVB , NO ADDED SOUNDS
    CVS: apex displaced to 6th ICS
    loud s1 +loud s2+ rumbling mid diastolic murmur
    abd : soft lax no tenderness no organomegaly
    CNS: GROSSLY NORMAL

    SO WHAT IS THE DIAGNOSIS? AND WHAT IS THE PLAIN OF MANAGEMENT FOR THIS CASE?

    Dr.aboashsha
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    عدد المشاركات : 23
    المستوى : Intern doctor
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    تاريخ التسجيل : 11/06/2009

    حصرى رد: 35years old man RECURRENT attake of palpitation

    مُساهمة من طرف Dr.aboashsha في السبت 30 يناير 2010, 11:56 am

    I think the most common caus of mitral valve stenosis is rheumatic heart disease so clinically I think the diagnosis stright forword: a rheumatic heart disease without develpement of faliure,mitral stenosis with atrial fibrillation comlicated with pulmonary hypertention and no signs suggesting SBE.Diagnosis must be confirmed first by CXR ECG and echo and ivestgation for the cause although stenosis occure after many years of rheumatic activityI think the patient is NYHA class 3 or four and both are indication for surgerythe patient must recieve a low dose of diuretis to relief dyspnoea, and for AF digoxin and warfarin as a prophylaxis, some authers advice about antibiotic prophylaxis for SBE 

      الوقت/التاريخ الآن هو الأربعاء 17 أكتوبر 2018, 4:29 pm