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Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Informant :Father ,Mother & self(reliable)

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No h/o CHD - PowerPoint PPT Presentation


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Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Informant :Father ,Mother & self(reliable) DOA:17-03-05. No h/o cough, fever, chest indrawing No h/o palpitation,edema of feet,decrease urine output.

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Presentation Transcript
slide1
Name :PUJAPPA
  • Age :14yrs
  • Sex :Male
  • Address:Marenali

Bagnur post ,yelanka ,Bangalore North.

  • Informant :Father ,Mother & self(reliable)
  • DOA:17-03-05
slide2
No h/o cough, fever, chest indrawing
  • No h/o palpitation,edema of feet,decrease urine output.
  • No h/o headache,vomiting,convulsions,

weakness of limbs.

slide3
Past h/o:h/o URI 2-3 times /year

No h/o suggestive of ALRI

No h/o admission to hospital

  • Family h/o:non consanguineous marriage.
slide5
Birth h/o:unbooked & unimmunised

1—no h/o drug intake,fever with rash

2--- no h/o suggestive PIH,DM

home delivery conducted by untrained dai.

BCIAB avg wt baby.prelacteal feeds sugar water 2-3spoons .started breast feeding 2hr after birth till 5months.

No h/o intermittent feeds

No h/o sweating over forehead during feeding

slide6
No h/o fever ,cough, chest indrawing.
  • Immunisation h/o:

Unimmunised(unawareness)

  • Development h/o:appropriate for age.
slide7

Required

Required

Getting

Getting

deficit

deficit

2400 Kcal

2400 Kcal

1400

1400

58%

58%

70 gms

70 gms

48

48

65%

65%

NUTRITION H/o

slide8
Socioeconomic h/o:Father 1st std ,Mother illiterate --coolie Rs 500/month.

1room 1kitchen kerosene stove cooking

out door sanitation.

low socioeconomic status

summary
summary
  • 14yr old male boy pujappa 5th child of non consanguineous marriage presented with

h/o breathlessness on exertion with squatting episodes since age of 3yrs.

h/o cyanosis

h/o not gaining wt.

no h/o repeated ALRI/CCF

slide10
CCHD with decrease pulmonary blood flow
  • TOF
  • TGV with VSD with PS
  • DORV with PS
  • Single ventricle with PS
anthropometry
ANTHROPOMETRY

expected

  • Wt 24kg (5th centile) 35kg
  • Ht 142cm(25th centile)150cm
  • HC 51cm
  • CC 57cm
  • Wt age
  • Ht age 13 yrs weight more affected
  • Wt for ht 77.4 than height
  • US/LS 0.9
vitals
VITALS
  • PR -72/min regular, good volume,all

peripheral pulses well felt,no R-R,no

R-F delay

  • BP- 100/68mmhg—UL, 110/70 –LL.
  • RR-18/min
  • Temp –Afebrile
  • JVP--N
head to toe examination
HEAD TO TOE EXAMINATION
  • Head –N
  • Eyes –conjunctival xerosis,conjunctival suffusion
  • Ears –N
  • Nose –N
  • Neck –no lymphadenopathy
  • Mouth – lips & tongue –cyanosis ,no caries
  • Hands –nails –cyanosis,clubbing –grade 3
  • Feet –toes-- cyanosis,clubbing –grade 3,no pedal edema
  • SMR –stage 2
slide14
Thorax & abdomen –Branding marks +
  • Skin –N
  • Bones & joints –N
  • Spine– N
  • No facial dysmorphism
  • No extracardiac markers
  • No features of infective endocarditis.
systemic examination
SYSTEMIC EXAMINATION
  • PR-72/min BP-100/68-UL,110/70-LL

JVP-N

  • Inspection :Apical impulse seen in 4th ICS

medial to MCL.

No precordial bulge

No other visible pulsations.

slide16
Palpation :Apical impulse seen in 4th ICS

0.5cm medial to MCL,Normal.

Thrill left 2,3,4 ICS along sternal border.

Parasternal heave grade 1

no epigastric pulsation,

no palpable P2

Percusion :left border corresponds to apex.

slide17
Auscultation :heart sounds S1 S2 heard

ejection systolic murmur of grade 4 heard best in left upper sternal border with diaphragm ,during inspiration,with sitting posture.

MA:S1S2+ same ejection systolic murmur +

PA : S1S2+, single S2,well heard , same ejection systolic murmur .

TA: S1S2+

AA:S1S2+

slide18
RS :Trachea central

B/L symmetrical chest movement+

B/L air entry

NVBS+

  • P/A:Soft

no organomegaly ,BS+

  • CNS:No focal neurological deficits.
slide19
Impression :CCHD with decreased pul blood flow in sinus rhythm, with out failure,

with no evidence of IE.

TOF

DORV with PS

TGV with VSD with PS

investigations
Investigations
  • Hb :16.8 gm/dl
  • PCV:58.8%
  • TC-8,600cells/cumm
  • DC N-71% L-22% E-4% M-3%
  • RBC 7.55million/cumm
  • Platelet :2.23lac
  • PBS:normocytic normochromic
slide22
ECG:HR-72/min

regular rhythm

PR interval 0.16sec

QT interval 0.32 sec

Right axis deviation (+120)

RVH –Tall R wave in V1 &deep S wave in V6

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