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.