Cvs and the system, case presentation

1. Cardiovascular System:
MITRAL REGURGITATION
Christina Thomas
Moderator- Dr.S.Prabhushankar

2. • Mr xyz a 46 year old male from Trichy who is a
teacher by occupation came to OPD with
chief complaints of
breathlessness and easy fatigability for past 5
months,
palpitation for past 3 months, and
cough for past 3 weeks

3. HISTORY OF PRSENT ILLNESS
• The patient was apparently normal before 5 months
after which he developed breathlessness which was
acute in onset gradually progressive. Initially the
patient developed breathlessness on exertion ,now the
patient experiences breathlessness on doing normal
day to day activities.
• Breathlessness aggravated on lying down
• H/o awakening from sleep at night due to
breathlessness for past 3 months and it decreased on
sitting posture.
• No seasonal variation noted

4. • The patient also complains of easy fatigability
for the past 5 months.
• H/o palpitation on exertion for past 3 months
which was irregular ,which was relieved on
rest which was associated with sweating .
• H/o cough for 3 weeks which was non
productive
• No seasonal and diurnal variation

5. • No H/O chest pain
• No h/o syncope
• No h/o cyanosis
• No h/o fever
• No h/o reduced urine output
• No h/o jaundice

6. PAST HISTORY
• The patient developed fever with joint pain
and swelling at 14 years of age. The joint
swelling was initially noted over the ankle and
it later migrated to knee joint for which he had
taken treatment from GH.
• Not known case of DM,HT ,tuberculosis,
bronchial asthma
• No history of any thyroid disorder
• No previous surgery

7. • FAMILY HISTORY
• No previous h/o sudden cardiac death in family
• PERSONAL HISTORY
consumes mixed diet
normal bowel and bladder habits
disturbed sleep pattern due breathlessness
• SOCIOECONOMIC HISTORY- Belongs to class III
Socioeconomic status.

8. • SUMMARY
A 46 year old male belonging to class III SEC
presented with complaints of easy fatigability,
progressive breathlessness and orthopnoea . He
also has history of irregular palpitation and
progressive non productive cough worsening over
past 2 weeks. Past history of fever with joint pain
and swelling present.
The system involved is the cardiovascular system
and probable diagnosis is rheumatic heart disease.

9. GENERAL EXAMINATION
• Patient is conscious oriented to time place and
person ,moderately built and nourished.
• He has mild pallor
• No icterus,cyanosis, clubbing
• No generalized lymphadenopathy
• Bilateral pitting pedal edema present.
• No external markers for Infective endocarditis,
Congenital heart disease, Coronary artery disease
and Rheumatic fever.

10. • VITALS
Pulse:110bpm ,regular rhythm, large
volume,normal character, no radio-radial or radio-
femoral delay, all peripheral pulses felt.
Blood pressure : 150/80 mmHg in right arm in
sitting position
Respiratory rate :17/min abdomino thoracic type
Temperature : afebrile
JVP: elivated jvp

11. • INSPECTION
Trachea appears to be in midline
Chest wall symmetrical
Presence of precordial bulge
Apex beat seen in left 6th intercostal space,
lateral to mid-clavicular line.
No dilated veins,no scars ,no sinuses

12. • PALPATION
• Inspectory findings are confirmed on
palpation- Trachea in midline.
• Apex beat- Hyperdynamic, felt in left 6th
intercostal space, lateral to mid-clavicular line.
• Parasternal heave felt in the parasternal line.
• Palpable systolic thrill is present at the apex.
• Palpable P2.

13. • AUSCULTATION-
• Mitral area- soft S1 heard.
• Tricuspid area- S1 and soft S2 heard.
• Aortic area- S1 and loud S2 heard.
• Pulmonary area- Loud P2.
• Murmur- A pan-systolic murmur ,high pitched
soft blowing systolic murmer ,of grade 4 is heard
with diphragm of stethoscope conducted to axilla
and back with patient in left lateral position and
the end of expiration

14. • OTHER SYSTEM EXAMINATION
• RESPIRATORY SYSTEM – normal vesicular
breath sounds
• CNS – no focal neurological deficit
• GIT – abdomen soft, no organomegaly

15. • SUMMARY –
• A 46 year old male from Trichy , belonging to middle
class presented with c/o easy fatigability, progressive
breathlessness, irregular palpitations and non-
productive cough worsening for past 2 weeks.
• On examination, elevated JVP, pitting pedal edema,
hyperdynamic apex beat shifted down and out.
Pansystolic murmur of grade 4 heard at the apex and
radiating to back. Parasternal heave noted. The
findings are suggestive of acquired valvular heart
disease- Mitral regurgitation.

16. • DIAGNOSIS- A case of acquired valvular heart
disease, probably of rheumatic etiology-
mitral reurgitation, with pulmonary
hypertension, atrial fibrillation and evidence
of congestive heart failure, without signs of
infective endocarditis.

17. • INVESTIGATIONS-
• Chest X-ray- PA view: Cadiomegaly (LVH,
enlarged LA), signs of pulmonary venous
congestion, edema.
• ECG- Dilated LA and LV
• ECHO- Dilated LA and LV, reurgitation
detectable.

18. • TREATMENT-
• Medical
• Digitalis,diuretics ( CCF)
• Anticoagulants
• IV nitroprusside
• Surgical
• Mitral valve replacement or repair