[11/16, 10:08 PM] Rakesh Biswas: Vivek, Pratya any inputs? [11/16, 10:25 PM] Pratya Bhowal: He didn't receive anti rabies immunoglobulin after that dog bite but only tetanus.
That's another issue.
But his complaints of breathlessness on exertion and above umbilical pain which migrated upwards and reached his "heart" according to him..at that point the pain got more severe in intensity and he lost consciousness.
That was 3/4 years back now recently he's suffering from frank dyspnoea and chest pain.
"Local doctor" said "heart e jhol jomeche".
Pericardial effusion ? [11/16, 10:26 PM] Pratya Bhowal: That above umbilical pain migrating upwards to mid chest and then he lost consciousness. This is where I'm clueledd about anything. [11/16, 10:27 PM] Pratya Bhowal: *clueless* [11/16, 10:27 PM] Ashwini BMJ Elective: Can someone please translate the history into English? [11/16, 10:31 PM] Rakesh Biswas: Yes Pratya did it partly above I guess 🙂 [11/16, 10:31 PM] Pratya Bhowal: Maybe we can ignore that mild above umbilical pain. [11/16, 10:32 PM] Pratya Bhowal: ? [11/16, 10:32 PM] Rakesh Biswas: What is your diagnosis? [11/16, 10:34 PM] Pratya Bhowal: Sudden onset chest pain with loss of consciousness.
Cardiac tamponade
Aortic stenosis
Pulmonary Embolism
Functional ? [11/16, 10:35 PM] Pratya Bhowal: Any pathology in ascending aorta like dissection. [11/16, 10:36 PM] Pratya Bhowal: Can't be sure without an echo. [11/16, 10:36 PM] Rakesh Biswas: How about myocardial infarction followed by a persistent congestive cardiac failure. I thought you saw his echo report. It's there. [11/16, 10:37 PM] Pratya Bhowal: No I didn't [11/16, 10:38 PM] IQ Std Ravi: Yes sir echo shows left atria & ventricle enlargement [11/16, 10:38 PM] Pratya Bhowal: Can acute mi cause sudden loss of consciousness? [11/16, 10:40 PM] Rakesh Biswas: Not sure how but we may be missing a lot of history there in the detailed sequence of actual events [11/16, 10:41 PM] Pratya Bhowal: Yes it would have been better if we got to ask him directly.
But thats not possible here I guess. [11/16, 10:46 PM] Rakesh Biswas: Ask Prodip babu to allow you to take the history directly. His number is there. He posted this case above [11/16, 10:59 PM] Vivek Poddar: Patient has IVS hypokinesia with EF 47% and LV and LA dilatation is suggesting that chronic volume overload led to LV dilation and increased back pressure led to LA dilation with pulmonary edema causing short of breath indicating chronic systolic heart failure.
Chest pain asssociated with loss of consciousness would indicate an arrhythmia. [11/16, 11:00 PM] Rakesh Biswas: Yes Pratya he may have had a VT followed by syncope and loss of consciousness [11/16, 11:00 PM] Vivek Poddar: And that arrhythmia can occur whenever there is a scar in the myocardium after MI [11/16, 11:03 PM] Vivek Poddar: But mild pericardial effusion could occur due to free wall rupture after MI but that is not the cause here. Why would there be pericardial effusion? [11/16, 11:04 PM] Pratya Bhowal: I have this same question too. [11/16, 11:05 PM] Pratya Bhowal: And I did not know until now after reading that Arrhythmias can cause chest pain too.
Yes, then indeed it can be due to that cause. [11/16, 11:08 PM] Vivek Poddar: This is why in the movies you see that after some stressfull news actor get heart attack as that triggers tachycardia and shortens diastolic time ( LV is perfused during diastole) and further compromising blood supply in the setting of previous coronary atherosclerosis [11/16, 11:09 PM] Vivek Poddar: Onething I would also say that LA dilatation itself can cause atrial fibrilation causing pulmonary edema in the back and syncopal attack forward (if that conducts through AV node). [11/17, 6:11 AM] Rakesh Biswas: Mild pericardial effusion is a very common finding in heart failure [11/17, 6:37 AM] Vivek Poddar: Oh okay Sir. Thanks
Dakthar babu Local Dr Bolachay ja Heard A jAL Hoaychay Bukay Halka Batha Akta Advice dela kub Upokar Hoay .
উত্তরমুছুন[11/16, 10:08 PM] Rakesh Biswas: Vivek, Pratya any inputs?
উত্তরমুছুন[11/16, 10:25 PM] Pratya Bhowal: He didn't receive anti rabies immunoglobulin after that dog bite but only tetanus.
That's another issue.
But his complaints of breathlessness on exertion and above umbilical pain which migrated upwards and reached his "heart" according to him..at that point the pain got more severe in intensity and he lost consciousness.
That was 3/4 years back now recently he's suffering from frank dyspnoea and chest pain.
"Local doctor" said "heart e jhol jomeche".
Pericardial effusion ?
[11/16, 10:26 PM] Pratya Bhowal: That above umbilical pain migrating upwards to mid chest and then he lost consciousness. This is where I'm clueledd about anything.
[11/16, 10:27 PM] Pratya Bhowal: *clueless*
[11/16, 10:27 PM] Ashwini BMJ Elective: Can someone please translate the history into English?
[11/16, 10:31 PM] Rakesh Biswas: Yes Pratya did it partly above I guess 🙂
[11/16, 10:31 PM] Pratya Bhowal: Maybe we can ignore that mild above umbilical pain.
[11/16, 10:32 PM] Pratya Bhowal: ?
[11/16, 10:32 PM] Rakesh Biswas: What is your diagnosis?
[11/16, 10:34 PM] Pratya Bhowal: Sudden onset chest pain with loss of consciousness.
Cardiac tamponade
Aortic stenosis
Pulmonary Embolism
Functional
?
[11/16, 10:35 PM] Pratya Bhowal: Any pathology in ascending aorta like dissection.
[11/16, 10:36 PM] Pratya Bhowal: Can't be sure without an echo.
[11/16, 10:36 PM] Rakesh Biswas: How about myocardial infarction followed by a persistent congestive cardiac failure. I thought you saw his echo report. It's there.
[11/16, 10:37 PM] Pratya Bhowal: No I didn't
[11/16, 10:38 PM] IQ Std Ravi: Yes sir echo shows left atria & ventricle enlargement
[11/16, 10:38 PM] Pratya Bhowal: Can acute mi cause sudden loss of consciousness?
[11/16, 10:40 PM] Rakesh Biswas: Not sure how but we may be missing a lot of history there in the detailed sequence of actual events
[11/16, 10:41 PM] Pratya Bhowal: Yes it would have been better if we got to ask him directly.
But thats not possible here I guess.
[11/16, 10:46 PM] Rakesh Biswas: Ask Prodip babu to allow you to take the history directly. His number is there. He posted this case above
[11/16, 10:59 PM] Vivek Poddar: Patient has IVS hypokinesia with EF 47% and LV and LA dilatation is suggesting that chronic volume overload led to LV dilation and increased back pressure led to LA dilation with pulmonary edema causing short of breath indicating chronic systolic heart failure.
Chest pain asssociated with loss of consciousness would indicate an arrhythmia.
[11/16, 11:00 PM] Rakesh Biswas: Yes Pratya he may have had a VT followed by syncope and loss of consciousness
[11/16, 11:00 PM] Vivek Poddar: And that arrhythmia can occur whenever there is a scar in the myocardium after MI
[11/16, 11:03 PM] Vivek Poddar: But mild pericardial effusion could occur due to free wall rupture after MI but that is not the cause here. Why would there be pericardial effusion?
[11/16, 11:04 PM] Pratya Bhowal: I have this same question too.
[11/16, 11:05 PM] Pratya Bhowal: And I did not know until now after reading that Arrhythmias can cause chest pain too.
Yes, then indeed it can be due to that cause.
[11/16, 11:08 PM] Vivek Poddar: This is why in the movies you see that after some stressfull news actor get heart attack as that triggers tachycardia and shortens diastolic time ( LV is perfused during diastole) and further compromising blood supply in the setting of previous coronary atherosclerosis
[11/16, 11:09 PM] Vivek Poddar: Onething I would also say that LA dilatation itself can cause atrial fibrilation causing pulmonary edema in the back and syncopal attack forward (if that conducts through AV node).
[11/17, 6:11 AM] Rakesh Biswas: Mild pericardial effusion is a very common finding in heart failure
[11/17, 6:37 AM] Vivek Poddar: Oh okay Sir. Thanks