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Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Infor

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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Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Infor

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  1. Name :PUJAPPA • Age :14yrs • Sex :Male • Address:Marenali Bagnur post ,yelanka ,Bangalore North. • Informant :Father ,Mother & self(reliable) • DOA:17-03-05

  2. 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.

  3. 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.

  4. No h/o CHD

  5. 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

  6. No h/o fever ,cough, chest indrawing. • Immunisation h/o: Unimmunised(unawareness) • Development h/o:appropriate for age.

  7. 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

  8. Socioeconomic h/o:Father 1st std ,Mother illiterate --coolie Rs 500/month. 1room 1kitchen kerosene stove cooking out door sanitation. low socioeconomic status

  9. 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

  10. CCHD with decrease pulmonary blood flow • TOF • TGV with VSD with PS • DORV with PS • Single ventricle with PS

  11. 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

  12. 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

  13. 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

  14. Thorax & abdomen –Branding marks + • Skin –N • Bones & joints –N • Spine– N • No facial dysmorphism • No extracardiac markers • No features of infective endocarditis.

  15. 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.

  16. 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.

  17. 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+

  18. RS :Trachea central B/L symmetrical chest movement+ B/L air entry NVBS+ • P/A:Soft no organomegaly ,BS+ • CNS:No focal neurological deficits.

  19. 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

  20. 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

  21. 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

  22. Chest X-ray: • ECHO:

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