CASE REPORT
A 52-year male with extremely poor general condition showed symptoms of breathlessness, abdominal distension, pedal swelling, and decreased urine output. On general examination, his heart rate was 140/minute, blood pressure of 95/30mm of Hg, respiratory rate of 35/min, saturation of 90% at room air with presence of anasarca. During examination of cardiovascular system, a diastolic murmur was audible at aortic area. On examining the respiratory system, we got crepitations on both lung fields. A diagnosis of acute decompensated heart failure was made on clinical ground.
On routine blood investigations, total leucocyte count was high with polymorphic leukocytosis, and there was deranged LFTs and deranged kidney function tests.
On Chest X ray, we found cardiomegaly with prominent aortic knob along with increased para-hilar vascularity, bilateral blunted costophrenic angles. ECG showed low voltage waves with features of left ventricular diastolic overload. Bedside 2D trans-thoracic ECHO(TTE) revealed poor LVEF of 25%, global hypokinesia, severe aortic regurgitation and dilatation of aortic root and ascending aorta (ascending aorta 6.2cm). CT angiography of heart and great vessels could not be done because of deranged renal function and respiratory distress of the patient.
The patient was managed conservatively initially with inotropes, judicious use of diuretics, IV antibiotics (renally safe), high flow oxygen and intermittent noninvasive positive pressure ventilation (NIPPV/BiPAP) and strict intake-output charting.