01-08-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[01-08-2025 PPM 1: Afternoon session:
Courtesy yesterday's data shared by @PPM3
70F with acute cerebral stroke and acute posterior wall and inferior wall myocardial infarction. Discussion on ECG and echocardiography findings with images of handwritten history and progress notes for archival.
[01-08-2025 15.40] PPM 1: https://youtu.be/Q8qLXTe12ug?si=Cd5phLYsGUaQLXPW
[01-08-2025 15.41] PPM 1: 👆Also for @PPM4 's Web 3.0 system to process.
[01-08-2025 15.47] PPM 1: https://youtube.com/shorts/hIC-dz01vxQ?si=odzHwNJ16HybrHAK
[01-08-2025 21.31] PPM 1:
[01/08, 15:50] Dhu Pm: Sir
Ecg image quality reduced by whatsapp
[01/08, 16:05]cm: True but on checkin it appears sufficient to make the diagnosis
[01/08, 16:06]cm: Focus on the changes evolving in V1V2 and 2,3, aVF
[01/08, 16:15] Dhu Pm: i have this notes sir
I'm still under confident in understanding Ecg sir.
Attaching notes, please guide me via that recent reports you shared.
(wrote this notes myself by listening to Gmeet class 3 yrs ago)
[01/08, 16:37]cm: Keep practicing by seeing the real patient ECGs we posted in the group and keep asking us questions on it.
That's the only way to learn ECGs practically quickly and usefully.
[01/08, 16:41] Dhu Pm: okay sir
I saw 2d echo
I saw
some whitish appearance on the screen where you pointed to posterior wall and anterior wall
Hypokinesia /dyskinesia (reduced movement or abnormal movement)
I understood that part vi a 2decho
how does that interpret on ECG sir
[01/08, 16:42]cm: Good
So now you just need to know where are the inferior and posterior walls represented on the ECG
Ask google and or chatGPT
[01/08, 16:46] Dhu Pm: got this info from google sir
Inferior wall ischemia in an ECG is primarily represented by changes in leads II, III, and aVF, while posterior wall ischemia is indicated by changes in leads V1-V4, specifically ST depression and tall R waves, or by ST elevation in leads V7-V9. These leads correspond to the areas of the heart supplied by the right coronary artery (RCA) and potentially the left circumflex artery (LCx) for the inferior wall, and the RCA or LCx for the posterior wall.
[01/08, 16:48]cm: Now check what serial changes are visible in the patient's ECGs and let me know
[01/08, 17:04] Dhu Pm: On 30th ecg 7am
Lead II, III ,aVF - T wave inversion
on 30th 9.30 am
I could see a t wave inversion on lead III
and flat t wave in II and aVF
on 31st 6 am
II - flat T wave
III - depressed t wave
aVF - looks flat (doubtful)
on1st 1pm
II, III, aVF - flat T waves
[01/08, 17:04] Dhu Pm: Correct me sir still not sure 😅
[01/08, 17:11]cm: What about 28-29?
[01/08, 17:12]cm: What about V1, V2?
[01/08, 17:21] Dhu Pm: 28th 12.15 pm
II - flat T wave
III- no Proper pqrs waves
aVF - inverted T wave
V1- ST elevation
v2- slight ST elevation,R wave >5mm
v3 - Slight ST elevation R wave >5mm
29th 1.08 pm
II- T wave flat
III- p wave depression and st elevation
aVF T wave depression
V1-St elevation, R wave >5mm
v2-St elevation, R wave >5mm
v3 -St elevation, R wave >5mm
29th 8.30 pm
II -T flat
III- T depression
aVF- T depression
V1- ST elevated, S appears Deep
v2-ST elevated, S appears Deep
v3 - ST elevated, S appears Deep
[01/08, 17:32] Dhu Pm: 30th 7am
Lead II, III ,aVF - T wave inversion
V1, v2, v3 - ST SEGMENT ELEVATION AND s waves appear deep (doubtful)
30th 9.30am
I could see a t wave inversion on lead III
and flat t wave in II and aVF
v1,v2,v3 - ST elevation, R wave (>5mm)
31st 6am
II - flat T wave
III - depressed t wave
aVF - looks flat (doubtful)
V1,v2,v3 - st elevation
1st 1pm ecg
II, III, aVF - flat T waves
V3- Tall R wave (>5mm)
and T wave inversion
[01/08, 20:19]cm: In 2,3, avF the most important feature after the STEMI pattern on 29th is the appearance of Q waves suggestion an evolving inferior wall myocardial infarction
In V1, V2 it's ST depression, not elevation but if one holds it against a mirror then it can appear as an elevation and this is a hallmark of posterior wall myocardial infarction.
[01/08, 20:33] Dhu Pm: I remember that reverse interpretation is because of the direction of current
does that apply here sir.
[01/08, 20:34] Dhu Pm: and I vaguely remember we should cross check those v2 v3 leads from other v567 leads
[01/08, 20:38] Dhu Pm: Sir are these considered as Q waves?
[01/08, 20:38] Dhu Pm: I see a dip after p wave
[01/08, 20:39]cm: Yes
[01/08, 20:39]cm: Yes it's a qs pattern
[01/08, 20:41] Dhu Pm: Sir is this V tach
[01/08, 20:47]cm: Can't happen in a single lead alone
[01/08, 21:05] Dhu Pm: So what could it be sir
[01/08, 21:18]cm: Transient local lead 2 problem
[02-08-2025 11:31] PPM 4: For deidentification and archival purposes, here's the processed summary of the MRI brain report for the 70-year-old female patient, with all personal identifiers removed:
---
*🧠 MRI Brain (Plain) – Deidentified Summary*
*Patient Demographics:*
* Age: 70 years
* Sex: Female
* Clinical Department: General Medicine
*MRI Protocol Used:*
* Axial T1, T2, FLAIR, DWI & SWI
* Coronal T2
* Sagittal T1
---
### *Key Radiological Findings:*
1. *Chronic Lacunar Infarcts*
* *Location*: Left thalamus
* *Etiology*: Likely secondary to chronic small vessel disease
2. *Bilateral Confluent Periventricular Hyperintensities*
* Suggestive of *chronic microangiopathic ischemic changes*
3. *No Acute Infarction*
* *DWI sequences*: No restriction (no acute infarcts)
4. *No Hemorrhage, Calcifications, or Vascular Malformations*
* *SWI sequences*: No microbleeds or vascular anomalies
---
### *Normal Structures Reported:*
* *Basal ganglia & right thalamus*
* *Brainstem and cerebellum*
* *Craniovertebral and cervicomedullary junctions*
* *Sella, pituitary, parasellar regions*
* *Hypothalamus, pituitary stalk, and posterior pituitary bright spot*
* *Orbital and globe contents*
* *Cortical gray/white matter differentiation preserved*
---
### *Final Impression:*
* ✅ *Chronic lacunar infarcts in left thalamus*
* ✅ *Chronic small vessel ischemic changes*
---
Let me know if you'd like this in a formatted PDF for upload to your case archive or integrated into the KIMS Hospital Syndrome CBBLE data set. I can also tag this for future reference under anonymized IDs.
[02-08-2025 11:34] PPM 4: Thank you,. Here's a deidentified and archivally formatted summary for the *MRI Brain Plain* report you shared for a 70-year-old female patient, suitable for inclusion in your KIMS Hospital syndrome CBBLE repository:
---
### *Case Summary: MRI Brain (Plain) — Elderly Female (70F)*
*Institution:* Kamineni Institute of Medical Sciences, Narketpally
*Date of MRI:* 28/07/2025
*Study Type:* MRI Brain Plain
*Sequences Used:* Axial T1, T2, FLAIR, DWI & SWI; Coronal T2; Sagittal T1
#### *Key Findings:*
* *Chronic lacunar infarcts in the left thalamus.*
* *Bilateral confluent periventricular hyperintensities*, consistent with chronic small vessel ischemic disease.
* *Normal findings* in:
* Right thalamus and basal ganglia
* Cerebral cortex (preserved gray/white differentiation)
* Brainstem and cerebellum
* Cranio-vertebral and cervico-medullary junctions
* Sella, pituitary and parasellar region
* Hypothalamus and posterior pituitary bright spot
* Orbit and globe contents
* *No acute infarcts* on DWI.
* *No hemorrhages, calcifications, or vascular malformations* on SWI.
#### *Radiological Impression:*
* Chronic lacunar infarcts (left thalamus)
* Chronic small vessel ischemic changes
---
Would you like me to link this summary with the clinical video file or generate a table entry format for CBBLE archival?
Also, let me know if you want to flag this for any neurology or geriatrics inputs on cognitive risk correlation (e.g., vascular dementia scale integration).
[02-08-2025 17.03] PPM 1: Patient's chest X-ray and HRCT done yesterday.
[02-08-2025 17:28] PPM 1: https://youtube.com/shorts/OiKgeJZb_48?si=uKsyvJg_DsdQyP0j
[02-08-2025 17:29] PPM 1: https://youtube.com/shorts/typ6afQWGoU?si=J4G-3kAjBjg-VCqq
[02-08-2025 17:30] PPM 1: https://youtube.com/shorts/4ctcT2p-9ZE?si=vh7TXxJs8kwOKUIw
[02-08-2025 17:30] PPM 1: https://youtube.com/shorts/bRnOljIVHQg?si=StBj2bGAvoMsR_yJ
EMR SUMMARY
Age/Gender: 70 Years/Female
Address:
Discharge Type: Referred
Admission Date: 28/07/2025 12:37 PM
Name of Treating Faculty
(AP)
(SR)
Diagnosis
ACUTE NON-ST ELEVATION MYOCARDIAL INFARCTION (NSTEMI0-INFERIOR WALLRESOLVED,
DAY6 POST MI
ANTERIOR AND LATERAL WALLREGIONAL WALL MOTION ABNORMALITIES(RWMA)
SECONDARY TO SUSPECTED TRIPLE VESSEL CORONARY ARTERY DISEASE
PERSISTANT HYPOXIA-LIKELY MULTIFACTORIAL
PROBABLE LEFT VENTRICULAR DYSFUNCTION AND BASAL ATELECTASIS
TRANSIENT SYMPTOMATIC BRADYCARDIA WITH FIRST DEGREE AV BLOCK-UNDER
EVALUATION
POST MI STATUS WITH ONGOING CARDIAC MONITORING AND MEDICAL MANAGEMENT
OPTIMIZATION
ACUTE KIDNEY INJURY
Case History and Clinical Findings
PT WAS BROUGHT TO CASUALTY WITH C/O ALTERED SENSORIUM SINCE 2 HRS.PT WAS
APPARENTLY ASYMPTOMATIC 2 HRS AGO AFTER WHICH PATIENT HAD SUDDEN EPISODE OF GIDDINESS AND FALL.NO C/O INVOLUNTARY MOVEMENTS, FROTHING FROM MOUTH, INVOLUNTARY MICTURITION
H/O 1 EPISPODE OF INVOLUNTARY DEFECATION.
NO H/O FEVER, COUGH, SOB, COLD, PALPITATIONS
NO C/O PEDAL EDEMA, FACIAL PUFFINESS, DECREASED OR INCREASED URINE
OUTPUT, CONSTIPATION, LOOSE STOOLS, NAUSEA, VOMITING.
PAST HISTORY:
** Tentative Date Page-2
KIMS HOSPITALS
N/K/C/O HTN, T2DM, ASTHMA, EPILEPSY, TB, CAD, CVD
PERSONAL HSITORY:
NORMAL APETITE, REGULAR BOWEL, NORMAL MICTURITION, NO KNOWN ALLERGIES AND ADDICTIONS
GENERAL EXAMINATION:
PALLOR PRESENT
PEDAL EDEMA, CYANOSIS, ICTERUS, CLUBBING OF FINGERS, LYMPHADENOPATHY
ABSENT
VITALS: TEMP-98.7F PR:110BPM RR:26CPM BP: 120/70MMHG SPO2:96% ON RA GRBS:
120MG/DL
SYSTEMIC EXAMINATION
CVS , RS, PER ABDOMEN- NORMAL
CNS- HIGHER MENTAL FUNCTION INTACT
PATIENT IS CONSCIOUS, OBEYING COMMAND, ORIENTED TO PERSON PLACE TIME
TONE RIGHT- UPPER LIMB- NORMAL LEFT- UPPER LIMB- NORMAL
LOWER LIMB - NORMAL LOWER LIMB- NORMAL
REFLEXES RIGHT LEFT
BICEPS +2 +2
TRICEPS +2 +2
SUPINATOR
KNEE +1 +1
ANKLE +1
PLANTAR FLEXOR FLEXOR
REFERAL TO CARDIOLOGY I/V/O ECG CHANGES AND ELEVATED TROP I DEP 30/07/25
TREATMENT:
INJ/LASIX 40 MG IV OD
INJ.DOBUTAMINE 1 AMP IN 45 ML NS @3ML/HR
TAB.NICORANDIL 5MG PO BD
TAB.CLOPIDOGRIL -A 75/20 PO/HS
TAB.IVABRADIL 5MG PO/BD
TAB.MET-XL 12.5MG PO/OD
CONTINUE HEPARIN
PLAN TO ADD ALDACTON AND ACE INHIBITORS
** Tentative Date Page-3
KIMS HOSPITALS
PLAN FOR INJ.LASIX INFUSION ONCE BP IMPROVES
PLAN FOR CAG AFTER STABILISATION
REFERAL TO NEPHROLOGY I/V/O RAISED CREATININE ON 2/8/25
ADIVSE:IV FLUIDS NS 1ML/KG/HR FOR 12 HRS BEFORE AND AFTER THE PROCEDURE
INJ.N ACETYL CYSTEINE 1200MG IV/BD ONE DAY BEFORE AND ON THE DAY OF
PROCEDURE
COURSE IN THE HOSPITAL
70 YR OLD FEMALE CAME WITH ABOVE MENTIONED COMPLAINTS ,VITALS AT
PRSENTATION TEMP-102F PR:110BPM RR:26CPM BP: 120/70MMHG SPO2:86% ON RA GRBS:
120MG/DL CONSIDERING IT AS ALTERED SENSORIUM SECONDARY TO? GENERAL CLONIC SEIZURES (POST ICTAL CONFUSION)? MENINGOENCEPHALITIS STARTED ON ANTI EPILEPTICS, ANTIBIOTICS, AND OTHER SUPPORTIVE TREATMENT.MRI WAS DONE WHICH REVEALED CHRONIC LACUNAR INFARCTS, CHRONIC SMALL VESSEL ISCHEMIA
CHANGES.SERIAL ECGS SHOWED CHANGES CONSISITENT WITH ACUTE INFERIOR WALL MI WITH HIGHLY ELEVATED TROP I, SEVERE CARDIAC DYSFUNCTION, LOADING DOSES OF DUAL ANTIPLATELETS AND STATINS AND INJ.HEPARIN WERE GIVEN.CARDIOLOGY OPINION WAS TAKEN AND TREATMENT STARTEDWITH INOTROPES AND DIURETICS NIV SUPPORT AND OTHER SUPPORTIVE TREATMENT, CARDIOLOGIST ALSO ADVISED FOR CORONARY ANGIOGRAM POST STABILIZATION.WITH ABOVE ALL TREATMENT THERE WAS IMPROVEMENT IN SENSORIUM BUT PERSISTENT HYPOXIA AND OXYGEN
SUPPLEMENTATION DEPENDENCE WAS PRESENT.
SUSPECTING? PULMONARY EMBOLISM? PULMONARY PATHOLOGY HRCT WITH CTPA WERE DONE FINDINGS, NEGATIVE FOR PULMONARY THROMBO EMBOLISM, CONSOLIDATION IN POSTERIOR SEGMENT OF LUNG UPPER LOBE AND BASAL SEGMENTS OF RIGHT LUNG LOWER LOBE, DILATED LEFT VENTRICLE.
DURING COURSE IN THE HOSPITAL PATIENT HAS EPISODIC DROP IN SENSORIUM (3
EPISODES) LASTING FOR ABOUT AROUND 3 MIN, WITH COMPLETE RECOVERY POST
EPISODE. CASE WAS REVIEWED WITH CARDIOLOGIST IN VIEW OF ACUTE MI WITH
CARDIAC DYSFUNCTION AND SYNCOPAL ATTACKS, AND ADVISED FOR HOLTERS
MONITORING, CARDIAC DOPPLER AND CAG.SO THE SAME WAS EXPLAINED TO ATTENDERS AND THEY AGREED FOR IT.SO PATIENT IS REFERRED TO CENTRE FOR FURTHER CARDIOLOGIST INTERVENTION
Investigation
** Tentative Date Page-4
KIMS HOSPITALS
Arterial Blood Gas Analysis (ABG) 28-07-2025PH 7.31PCO2 40.1PO2 28.3HCO3 20. 0St.HCO3
19.2BEB -5.2BEecf -5.1TCO2 42.5O2 Sat 39.0O2 Count 5.8HEPATITIS- B SURFACE ANTIGEN
(HBSAg) RAPID TEST 28-07-2025 Negative ANTI HCV ANTIBODIES (Rapid Test) RAPID 28-07-2025
Non ReactiveR M 9.0 mg/dl PHOSPHOROUS 3.5 mg/dl SODIUM 136 mmol/LPOTASSIUM 3.3
mmol/L.CHLORIDE 95 mmol/L Arterial Blood Gas Analysis (ABG) 28-07-2025PH 7.38PCO2 28.3PO2
98.5HCO3 16.7 St. HCO3 18.9BEB -6.7BEecf -7.3TCO2 34.7O2 Sat 96.7O2 Count 14.2LIVER
FUNCTION TEST (LFT) 28-07-2025Total Bilurubin 1.06 mg/dl Direct Bilurubin 0.24 mg/dl SGOT(AST)
42 IU/LSGPT(ALT) 38 IU/LALKALINE PHOSPHATASE 119 IU/LTOTAL PROTEINS 6.0
gm/dl ALBUMIN 3.6 gm/dl A/G RATIO 1.5Arterial Blood Gas Analysis (ABG) 28-07-2025PH
7.395PCO2 25.6PO2 57.1HCO3 15.3 St.HCO3 17.8BEB -8.0BEecf -8.6TCO2 32.0O2 Sat 88.8O2
Count 12.2
2D ECHO ON 28/7/25
IMPRESSION:
GLOBAL HYPOKINETIC,MILD LVH+
MODERATE MR,MILD AR,MILD TR WITH PAH
SCLEROTIC AV,NO AS/MS IAS INTACT
EF >35% RVSP=48MMHG
SEVERE LV DYSFUNCTION +
GRADE 2 DIASTOLIC DYSFUNCTION +
MINIMAL PE +,NO LV CLOT
IVC SIZE (0.8CM) COLLAPSING
DILATED LA/LV
NO VEGETATIONS
MRI ON 28/7/25
IMPRESSION:
CHRONIC LACUNAR INFARCTS
CHRONIC SMALL VESSEL ISCHEMIA CHANGES
ULTRASOUND ON 28/7 /25
IMPRESSION:GRADE 1 RPD CHANGES OF LEFT KIDNEY
Arterial Blood Gas Analysis (ABG) 28-07-2025 11:37:PMPH 7.37PCO2 28.9PO2 60.7HCO3
16.4St.HCO3 18.2BEB -7.5BEecf -7.9TCO2 34.3O2 Sat 89.0O2 Count 12.4RFT 28-07-2025UREA
43 mg/dl CREATININE 1.6 mg/dl URIC ACID 5.6 mmol/LCALCIUM 8.7 mg/dl PHOSPHOROUS 2.8
mg/dl SODIUM 136 mmol/LPOTASSIUM 3.6 mmol/L.CHLORIDE 99 mmol/L
HEMOGRAM ON 28/7/25
** Tentative Date Page-5
KIMS HOSPITALS
HAEMOGLOBIN 9.9 gm/dl TOTAL COUNT 8,900 cells/cumm NEUTROPHILS 83 %LYMPHOCYTES 09 %EOSINOPHILS 01 %MONOCYTES 07 %BASOPHILS 00 % PCV 30.3 vol % M C V 80.8 fl M C H 26.5 pg M C H C 32.8 % RDW-CV 16.4 % RDW-SD 49.0 fl RBC COUNT 3.75 millions/cumm
PLATELET COUNT 2.31 lakhs/cu.mm RBC Normocytic normochromic WBC neutrophilia PLATELETS
Adeqaute HEMOPARASITES No hemoparasites seen IMPRESSION Normocytic normochromic
anemia
COMPLETE URINE EXAMINATION (CUE) 28-07-2025COLOUR Pale yellow APPEARANCE
Clear REACTION Acidic SP. GRAVITY 1.010ALBUMIN Nil SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS 3-4 EPITHELIAL CELLS 2-3 RED BLOOD CELLS Nil CRYSTALS Nil CASTS Nil AMORPHOUS DEPOSITS Absent OTHERS Nil Arterial Blood Gas Analysis (ABG) 29-07-2025PH 7.37PCO2 30.5PO2 60.6HCO3 17.5 St. HCO3 19.1BEB -6.4BEecf -6.7TCO2 36.4O2 Sat 89.3O2 Count 12.9RFT 29-07-2025UREA 45 mg/dl CREATININE 1.4 mg/dl URIC ACID 7.1 mmol/L CALCIUM 8.7 mg/dl PHOSPHOROUS 2.4 mg/dl SODIUM 138 mmol/L POTASSIUM 3.6 mmol/L.CHLORIDE 99 mmol/L Arterial Blood Gas Analysis (ABG) 29-07-2025PH 7.376PCO2 29.7PO2 89.1HCO3 17.0St.HCO3 18.8BEB -6.8BEecf -7.2TCO2 35.7O2 Sat 96.2O2 Count 13.0Arterial Blood Gas
Analysis (ABG) 30-07-2025PH 7.35PCO2 34.0PO2 30.7HCO3 18.3St.HCO3 18.7BEB -6.1BEecf -
6.3TCO2 39.3O2 Sat 50.2O2 Count 6.3
HEMOGRAM ON 30/7/25
HAEMOGLOBIN 8.9 gm/dl TOTAL COUNT 4,700 cells/cumm NEUTROPHILS 74 % LYMPHOCYTES 17 %EOSINOPHILS 01 %MONOCYTES 08 %BASOPHILS 00 %PCV 27.4 vol % M C V 79.6 fl M C H 25.8 pgM C H C 32.4 % RDW-CV 16.5 % RDW-SD 49.4 fl RBC COUNT 3.45 millions/cumm
PLATELET COUNT 1.93 lakhs/cu.mm RBC Normocytic normochromic WBC With in normal
limits PLATELETS Adeqaute HEMOPARASITES No hemoparasites seen IMPRESSION Normocytic
normochromic anemia
RFT 30-07-2025UREA 60 mg/dl CREATININE 1.7 mg/dl URIC ACID 8.3 mmol/LCALCIUM 9.2
mg/dl PHOSPHOROUS 2.8 mg/dl SODIUM 136 mmol/L POTASSIUM 3.0 mmol/L.CHLORIDE 99
mmol/L
LIVER FUNCTION TEST (LFT) 30-07-2025Total Bilurubin 0.35 mg/dl Direct Bilurubin 0.17
mg/dl SGOT(AST) 87 IU/LSGPT(ALT) 56 IU/LALKALINE PHOSPHATASE 119 IU/LTOTAL
PROTEINS 5.6 gm/dl ALBUMIN 3.3 gm/dl A/G RATIO 1.43Arterial Blood Gas Analysis (ABG)
31-07-2025 PH 7.39PCO2 31.8PO2 94.2HCO3 19.2 St. HCO3 20.8BEB -4.4BEecf -4.7TCO2 39.8O2 Sat
96.1O2 Count 13.9
HEMOGRAM ON 1/8/25
** Tentative Date Page-6
KIMS HOSPITALS
HAEMOGLOBIN 10.9 gm/dl TOTAL COUNT 5,800 cells/cumm NEUTROPHILS 54 %
LYMPHOCYTES 30 % EOSINOPHILS 01 %MONOCYTES 15 % BASOPHILS 00 % PCV 33.7 vol % M C V 81.5 fl M C H 26.3 pg M C H C 32.3 %RDW-CV 16.2 % RDW-SD 48.0 fl RBC COUNT 4.13 millions/cumm PLATELET COUNT 1.68 lakhs/cu.mm RBC Normocytic normochromic WBC With in
normal limits with monocytosis PLATELETS Adequate in number and distribution HEMOPARASITES
No hemoparasites seen IMPRESSION Monocytosis
SERUM ELECTROLYTES 01-08-2025 SODIUM 139 mmol/L POTASSIUM 3.0 mmol/L CHLORIDE 98 mmol/LRFT 01-08-2025 11:47:PM UREA 79 mg/dl CREATININE 1.8 mg/dl URIC ACID 8.2
mmol/L CALCIUM 10.0 mg/dl PHOSPHOROUS 3.1 mg/dl SODIUM 142 mmol/L POTASSIUM 3.0
mmol/L.CHLORIDE 98 mmol/L Arterial Blood Gas Analysis (ABG) 02-08-2025 06:36:AM PH
7.39 PCO2 32.8PO2 78.5HCO3 19.4 St. HCO3 20.8BEB -4.3BEecf -4.6TCO2 40.4O2 Sat 94.0O2
Count 13.6
HEMOGRAM ON 2/8/25
HAEMOGLOBIN 10.7 gm/dl TOTAL COUNT 11,000 cells/cumm NEUTROPHILS 46 %
LYMPHOCYTES 34 % EOSINOPHILS 00 % MONOCYTES 20 % BASOPHILS 00 %PCV 31.8 vol % M C V 78.9 fl M C H 26.6 pg M C H C 33.8 % RDW-CV 17.0 % RDW-SD 50.2 fl RBC COUNT 4.04 millions/cumm PLATELET COUNT 1.70 lakhs/cu.mm RBC Normocytic normochromic with few
microcytes WBC Within normal limits with increased monocytes PLATELETS Adequate in number
and distribution HEMOPARASITES No hemoparasites seen IMPRESSION Normocytic normochromic
2D ECHO ON 1/8/25
MILD AR, MILD MR, MILD TR, NO PAH
RWMA + LAD AKINESIA, RCA AND LCX HYPOKINETIC
SEVERE LV DYSFUNCTION, NO LV CLOT
GRADE 1 DIASTOLIC DYSFUNCTION, NO PE
CTPA ON 2/8/25
IMPRESSION:
NEGATIVE FOR PULMONARY THROMBO EMBOLISM
CONSOLIDATION IN POSTERIOR SEGMENT OF LUNG UPPER LOBE AND BASAL SEGMENTS
OF RIGHT LUNG LOWER LOBE
DILATED LEFT VENTRICLE
Treatment Given (Enter only Generic Name)
IVF NS @ 75 ML/HR IV/STAT
INTERMITTENT CPAP VENTILATION PLUS OXYGEN SUPPLEMENTATION TO MAINTAIN SPO2 >92%
FLUID RESTRICTION <1.5L/DAY
** Tentative Date Page-7
KIMS HOSPITALS
SALT RESTRICTION <2 GM/DAY
INJ.LEVIPIL 1 GM IV STAT F/B INJ.LEVIPIL 100MG IV/BD
INJ.MONOCEF 2 GM IV STAT F/B INJ.MONOCEF 2GM IV BD
INJ.LASIX 40 MG IV/BD IF SBP >110 MMHG
INJ.PAN 40 MG IV OD
INJ.NEOMOL 500MG IV QID 50-50-50-50
TAB MET-XL 12.5 MG PO/OD 1-0-0
INJ.HEPARIN 5000IU IV TID
TAB.ECOSPORIN GOLD 75/75/20 PO TID 0-0-1
TAB.PCM 650MG PO/TID 1-1-1
INJ.DOXYCYCLINE 100MG IV BD
INJ.DOBO 1 AMP IN 40ML NS @3ML/HR
INJ.LASIX 100MG IN 40 ML NS @ 2 ML/HR
TAB.NICORANDIL 5MG PO/BD
TAB.CLOPIDORIL 75/20 PO/HS X-X-9PM
TAB.IVABRADINE 5MG PO/BD 1-X-1
NEBS WITH IPRAVENT 6TH HRLY, BUDECORT 12TH HRLY, MUCOMIST 6TH HRLY
INJ.ACETYL CYSTEINE 120 MG IN 500 ML NS IV /BD OVER 8HRS
Advice at Discharge
FLUID RESTRICTION <1.5L PER DAY
SALT RESTRICTION <2G/DAY
TAB.TAXIM O 200MG PO/BD FOR 3 DAYS
TAB.DOXYCYCLINE 100MG PO/BD FOR 3 DAYS
TAB PAN 40 MG PO/OD FOR 7 DAYS
TAB DYTOR PLUS 10/50 MG (1/2 TAB) PO/BD FOR 7 DAYS(8AM-X-4PM)
TAB.LEVIPIL 500 MG PO/BD FOR 7 DAYS
TAB.ECOSPRIN GOLD 75/75/20 MG PO/HS TO BE CONTINUED
TAB.NICORANDIL 5 MG PO/OD FOR 7 DAYS
TAB.IVABRADINE 5 MG PO/OD FOR 7 DAYS
PT AND PT ATTENDERS HAVE BEEN COUNSELLED ABOUT THE PT CONDITION I.E ACUTE
NON ST ELEVATION MYOCARDIAL INFARCTION INFERIOR WALL(RESOLVED), DAY6 POST MI ANTERIOR AND LATERAL WALLREGIONAL WALL MOTION ABNORMALITIES(RWMA)
SECONDARY TO SUSPECTED TRIPLE VESSEL CORONARY ARTERY DISEASE
** Tentative Date Page-8
KIMS HOSPITALS
PERSISTANT HYPOXIA-LIKELY MULTIFACTORIAL
PROBABLE LEFT VENTRICULAR DYSFUNCTION AND BASAL ATELECTASIS
TRANSIENT SYMPTOMATIC BRADYCARDIA WITH FIRST DEGREE AV BLOCK-UNDER
EVALUATION
POST MI STATUS WITH ONGOING CARDIAC MONITORING AND MEDICAL MANAGEMENT
OPTIMIZATION AND NEED FOR HOLTER MONITORING AND CORONARY
ANGIOGRAPHY(CAG) HAVE BEEN EXPLAINED TO THE PATIENT IN T6HEIR OWN
UNDERSTANDABLE LANGUAGE I.E TELUGU
CASE HAS BEEN DISCUSSED WITH (CARDIOLOGIST) KHL, AND ADVISED
FOR HOLTER MONITORING ABD CORONARY ANGIOGRAPGY(CAG). SIR RECOMMENDED
SENDING THE PATIENT TO KHL FOR FURTHER EVALUATION
DOCTORS HOSPITAL STAFF ANG MANAGEMENT AND NURSE ARE NOT RESPONSIBLE FOR ANY UNTOWARD EVENTS OUTSIDE THE HOSPITAL
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE, DONOT MISS MEDICATIONS. In case of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact:
08682279999 For Treatment Enquiries Patient/Attendant Declaration: - The medicines prescribed
and the advice regarding preventive aspects of care, when and how to obtain urgent care have been
explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
Discharge Date
Date:2/8/25
Ward: AMC
Unit:1
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