A 60 year old female with SOB

60 YEAR OLD FEMALE WITH SOB,DYSPHAGIA

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JULY 28th ,2023

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SHIVANI THOTA

60 year old female came with chief complaints of

Dysphagia since 1 month
Chest tightness since 1 month
SOB since 1 month

HISTORY OF PRESENTING ILLNESS:

patient was apparently asymptomatic 1 month back when she noticed difficulty in swallowing(solids>liquids) which was insidious in onset, non progressive not associated with regurgitation of food,pain ,burning sensation,foul smell

Grade 1 Shortness of breath since 1 month which was insidious in onset,non progressive ,aggregates on exertion

H/O similar complaints in past since 1 year on and off

No H/O fever with chills, sore throat, vomitings, pain abdomen, weight loss

No H/O pedal edema, orthopnea, PND, dry cough

No H/O diarrhoea,tinnitus

10 years back in 2013 when she had complaints of sob on exertion and dysphagia then she was admitted in hospital ,after work up she was found to have Mitral valve prolapse then she underwent surgery(kawazoes la reduction plasty ) along with prosthetic valve placement on 3.9.2013

Tab.suhagra 12.5mg BD

Tab. Ecosprin 75mg OD

Tab.amifru 40 mg BD

Tab. Digoxin 0.25mg OD

She used above medication only for a month then she continued only sildinafin OD since after

2 months back She had complaints of dysphagia ,indigestion , burning in chest and bloating for which she consulted a gasteroenterologist. Endoscopy was done and sliding hiatus hernia with GRD B esophagitis was noted. HRCT chest was also done findings

Gross cardiomegaly
Prominent pulmonary trunk, PAH
Dialysed aortic root and ascending aorta

Since then She was put on pantop

Routine before surgery

daily wage worker , she used to sell toddy , did farming also for some days

Wakes up at 5am does her daily works has morning tea has rice with curry goes to work has rice for lunch and comes home at 5 am and have tea she has rice for dinner , she watches daily soaps for about 1-2 hrs and goes to sleep

At the age of 30 yrs She started smoking bedi(1 morning ,1 night) as to relieve throat congestion and stopped before surgery

She has toddy occasionally

Since surgery

She doesn’t go for any work.she spends time with her kids and grandkids and does her own work goes to market to get groceries.

She got married at the age of 20 and has 2 kids (sons)

1st son(30 yrs) - in 3rd trimester she had pedal edema, jaundice. She had normal vaginal delivery

2nd son(26 yrs) -normal vaginal delivery

PAST HISTORY:

No H/o DM,HTN,Epilepsy,Asthma,CVA,TB

No h/o HTN, asthma , seizures, CAD, CVA,TB

FAMILY HISTORY: insignificant

PERSONAL HISTORY:

Diet-mixed (since 10 days she’s having only idly)

Appetite-Normal (decreased since 10 days)

Sleep- adequate

Bowel and bladder- Normal, passing hard stools since 10 days

Addictions-

Smoking : stated at the age of 30 smoking beedi(1 morning ,1 night) as to relieve throat congestion and stopped before surgery

She has toddy occasionally