10-11-2025
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.
[10.01 pm, 10/11/2025] PPM 1: History of the patient: Delivered first twin daughters at the age of 20 and twin son and daughter at the age of 22.
5 years later she developed her first heart failure symptoms with generalized body swelling and shortness of breath that continued for 23 years since then and recently a week back she again developed severe shortness of breath and was admitted with severe atrial fibrillation precipitating severe heart failure.
[10.05 pm, 10/11/2025] PPM 1: https://youtu.be/xtzHJ0Ohb9w?si=rz-GrUmWijxD3TPE
[3.36 pm, 11/11/2025] PPM 1: https://youtu.be/_T7tnnJ1Tcs?si=CWpq1bCiIwLe5Z-f
https://youtu.be/4AdMVJ_eOVs?si=83oF-NgUt03y_ZhG
3.21 pm, 12/11/2025] PPM 1: Today's update also in the form of some heiroglyphic auscultation notes signed by @PPM3!
https://youtu.be/4AdMVJ_eOVs?si=83oF-NgUt03y_ZhG
3.21 pm, 12/11/2025] PPM 1: Today's update also in the form of some heiroglyphic auscultation notes signed by @PPM3!
Age/Gender: 50 Years/Female
Address:
Discharge Type: Referred
Admission Date: 05/11/2025 05:11 PM
Discharge Date: 15/11/2025 09:06 AM
Name of Treating Faculty
(HOD)
(AP)
(SR)
Diagnosis
1.ACUTE DECOMPENSATED HEART FAILURE WITH CARDIOGENIC SHOCK (RESOLVING)
WITH PERMANENT VALVULAR ATRIAL FIBRILLATION WITH FVR SECONDARY TO CHRONIC RHEAUMATIC HEART DISEASE WITH SEVERE MR AND MILD MS WITH CAD.
2. PRE RENAL AKI
3. TYPE II RESPIRATORY FAILURE
4. S/P MECHANICAL VENTILLATION (DAY 4)
5. GRADE II BEDSIDE ON RIGHT GLUTEAL REGION
Case History and Clinical Findings
PT WAS PRESENTED TO CASUALITY WITH C/O SOB SINCE 5 DAYS, RIGHT SIDED CHEST
PAIN SINCE 1 WEEK. HOPI: PT WAS APPARENTLY NORMAL 1 WEEK AGO, THEN SHE
DEVELOPED RIGHT SIDED CHEST PAIN, INCIDIUS ONSET, AGGRAVATED ON LYING ON
RIGHT SIDE, C/O SHORTNESS OF BREATH, INCIDIOUS ONSET, GRADUALLY PROGRESSIVE
TO GRADE IV MMRC/CLASS IV NYHA, C/O B/L PEDAL EDEMA SINCE 1 WEEK, GRADE II,
PITTING TYPE, AGGREVATED IN THE MORNING H/O ORTHOPNEA, PND. C/O CONSTIPATION
, PASSES HARD STOOLS - ONCE IN 3 DAYS, H/O FACIAL PUFFINESS. NO H/O
FEVER, COUGHT, COLD, PAIN ABDOMEN, LOOSE STOOLS, SIZURES, LOC
KIMS HOSPITALS
PAST HISTORY: H/O SIMILAR COMPLAINTS IN THE PAST (SINCE 20 YRS) K/C/O CAD-RHD
WITH SEVER MR, MS, SINCE 20 YRS ON CONSERVATIVE MANAGEMENT (STOPPED TAKING MEDICATION SINCE 5 DAYS) T. ISOLAZINE 20/37.5 1/2 TAB BD (STOPPED), T. DYTOR PLUS 10/50 MG OD(CONTINUED) PATIENT WAS SUGGESTED FOR MUR- BUT TREATED CONSERVATIVELY K/C/O AF WITH FVR + RBBB SINCE 20 YRS
N/K/C/O HTN, T2DM, CVA, TB, EPILEPSY, THYROID DISORDERS, ASTHMA
PERSONAL HISTORY: MARRIED, HOMEMAKER BY OCCUPATION, LOST APPETITE, MIXED
DIET, BOWEL MOVEMENTS - CONSTIPATION, BLADDER MOVEMENTS NORMAL,
ADDICTIONS ALCOHOLIC (TEETOTALER) FAMILY HISTORY: NOT SIGNIFICANT
GENERAL EXAMINATION: NO ICTERUS, CYANOSIS, CLUBBING OF FINGERS, GENERALISED
LYMPHADENOPATHY, PEDAL EDEMA PRESENT (GRADE 2), PALLOR PRESENT (MILD)
VITALS: TEMP: 98.6 F; BP: 110/70 MMHG; PR: 153BPM; RR: 24 CPM; GRBS: 121 MG/DL; SPO2:
84% @ RA
SYSTEMIC EXAMINATION: CVS: S1 S2 +, EJECTION SYSTOLIC MURMUR +; RS: BAE+, CLASS 4 NYHA (DYSPNEA) B/L FINE INSPIRATORY CREPTS; CNS: NFND; P/A: SOFT AND NON TENDER
50 YRS OLD FEMALE WHO IS A K/C/O RHD SINCE 20 YRS PERSISTENT AF WITH FVR NON
COMPLIENCE TO MEDICATION WAS BROUGHT TO CASUALITY BY THE ATTENDER WITH C/O SOB SINCE 5 DAYS (GRADE 4) AND RIGHT SIDED CHEST PAIN AT PRESENTATION PR
:150BPM IRREGULAR BP:100/70 MMHG RR:29CP SPO2:97%@ 4 LIT O2 AFTER THOUROUGH
EXAMINATION PT WAS DIAGNOSED AS ACUTE DECOMPENSATED HEART FAILURE
SECONDARY TO NON COMPLENCE TO DRUGS AF (LONGSTANDING) WITH FVR AND
TREATED WITH DIURETICS, ANTICOAGULANT + HEPERIN ON DAY2 PT DEVELOPED
HYPERTENSION IONOTROPES. SUPPORT (DOBUTAMINE) WAS STARTED ON DAY 3 DUEL
IONOTROPIC. SUPPORT WAS STARTED AS BP WAS NOT MAINTAINED, ON DAY 4
IONOTROPES WERE TAPPERED ON DAY 5 WHEN AFTER RATE CONTROLLING DRUG. PT AF WAS STILL PERSISTANT, PT AGAIN DEVELOPED HYPERTENSION, WENT INTO ACIDOSIS AND RESPIRATORY DISTRESS. PT WAS INTUBATED AND CONNECTED TO MECHANICAL VENTILATOR. DAY 5 PT WAS TREATED CONSERVATIVELY WITH INOTROPES, DIURETICS, ANTICOAGULANTS, CALCIUM CHANNEL BLOCKERS AND OTHER SUPPORTIVE MANAGEMENT. PT CONDITION WAS DISCUSSED WITH THE CARDIOLOGIST KIMS LB NAGAR. ADVICE MITRAL VALVE REPLACEMENT SURGERY +/- RADIOFREQUENCY
ABLATION AND PT WAS REFFERED TO KHL ON THEIR OPINION
Investigation
RFT (06-11-25): BU 88; CREAT 1.5; S.NA 133; S. K 4.1; S.CL 95
RFT (08-11-25): BU 50; CREAT 1.3; S.NA 136; S. K 4.1; S.CL 99
Page-2KIMS HOSPITALS
RFT (11-11-25): BU 83; CREAT 1.5; S.NA 142; S. K 3.8; S.CL 101
RFT (13-11-25): BU 96; CREAT 1.4; S.NA 136; S. K 3.6; S.CL 98
PT 18, INR 1.3, APTT 35
HEMOGRAM (06-11-25): HB 11.8; PCV 34.9; TLC 10300; RBC 4.0; PLT 1.1.
HEMOGRAM (08-11-25): HB 10.8; PCV 34.2; TLC 6600; RBC 3.8; PLT 1.1.
HEMOGRAM (11-11-25): HB 10.4; PCV 33.9; TLC 7700; RBC 3.8; PLT 1.4.
HEMOGRAM (13-11-25): HB 9.9; PCV 30.0; TLC 10300; RBC 3.4; PLT 1.2.
12-11-25 SEROLOGY- NEGATIVE
USG - 11/11/25
GRADE 1 RPD CHANGES IN B/L KIDNEYS LIKELY CLD, MODERATE ASCITIES, B/L RENAL
CORTICAL CYSTS
2D ECHO (06-11-25) AF DURING STADY RHD
GLOBAL HYPOKINESIA
SEVERE MR+, MODERATE MS+
MV = AML PROLAPSE, PML REVERSE DOMING THICKENED
MVG = MV. V MAX 2.24M/SEC, MV .MAX PG - 20.05 MMHG, MV MEAN PG - 9.92 MMHG
SCLEROTIC AV, NO AS, MODERATE MS+
EF= 42% MODERATE LV DYSFUNCTION+
GRADE III DIASTOLIC DYSFUNCTION +
MILD PE+ &PLEURAL EFFUSION+
LA SIZE 7.41CM
RA SIZE 6.34 CMS
TAPSCE - (1.53CMS) RV DYSFUNCTION+
IVC SIZE (1.80CM) DILATED NON-COLLAPSING
MILD PR+, DILATED MPA SIZE 3.10 CMS
Treatment Given (Enter only Generic Name)
RT FEEDS 50 ML WATER 2 HRLY, 100 ML MILK4 HRLY
IVF NS - DNS AND 30 ML PER HR WITH 1 AMP OPTINEURON IN 50 ML NS IV/OD
INJ MIDAZ INFUSION IV 5 ML PER HR INCREASED OR DECREASED Accordingly
INJ PIPTAZ 2.25GM IV TID
INJ LASIX 40 MG IV TID
TAB NARFARRIN 5 MG RT/OD
INJ DIGOXIN 2 ML (0.5MG) IN 8 ML NS - 1 ML /0.0625 MG IV/OD
TAB CARDRONE 100 MG RT/BD
Page-3KIMS HOSPITAL
TAB GLYCOPYROLATE 0.4 MG RT/BD
NEOSPORINE POWDER FOR L/A TID
POSITION CHANGE 4TH HRLY
CHEST Physiotherapy
FREQUENT ET AND ORAL SUCTIONING
Advice at Discharge
PATIENT ATTENDER HAVE BEEN EXPLAINED ABOUT THE PATIENTS CONDITION IN THEIR
OWN Understandable LANGUAGE (TELUGU) THAT IS. ACUTE DECOMPENSATED HEART
FAILURE WITH CARDIOGENIC SHOCK (RESOLVING) WITH PERMANENT VALVULAR ATRIAL FIBRILLATION WITH FVR SECONDARY TO CHRONIC Rheumatic HEART DISEASE WITH SEVERE MR AND MILD MS WITH CAD WITH VAP PRE RENAL AKI. TYPE II RESPIRATORY FAILURE. S/P MECHANICAL VENTILLATION (DAY 4). GRADE II BEDSIDE ON RIGHT GLUTEAL REGION AND NEED FOR MITRAL VALVE REPLACEMENT AND RFA IF REQUIRED. AFTER DISCUSSING THE CASE WITH CARDIOLOGIST, KHL PATIENT IS BEING REFERED TO HIGHER CENTER BUT THEY ARE TAKING PATIENT TO THEIR HOME ON THEIR OWN WILL DOCTORS, HOSPITAL STAFF AND MANAGEMENT ARE NOT RESPONSIBLE FOR ANY UNTOWARD EVENTS OF THE PATIENT OUTSIDE THE HOSPITAL @42MPA @PPM4 this global mainstream defensive medicine directive reminded me of your patient
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:14-11-25 Ward: ICU Unit: III
Page-4
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