Pulmonary Hypertension with BVF. *Chief Complaints* A 46 yr old female attended Mopd with progressive SOB and productive cough since 1 month with pedal edema since 10 days. No associated fever,chest pain,palpitation,Hemoptysis,Diaphoresis,pain abdomen etc. She is K/C/O Hypothyroidism and Br Asthma. No H/O HTN,DM,Substance abuse. Normal Menstrual Cycle. General Examination normal except B/l pedal edema and prominent Neck veins. Systemic Examination- B/l Infrascapular fine crepts with occasional Ronchi. Routine Ix was advised. Pt attended Mopd with reports showing- CXR - increased CT ratio suggestive of Cardiomegaly with b/l lower zone opacity. Sputum C/S normal flora. Rest blood Ix normal. ECG - multiple VPCs. 2D ECHO- 1. LV function is mildly depressed with estimated LVEF of 45%. 2. IVS and apex are mildly hypokinetic. 3. Right Atrium & Left Atrium are dilated. 4. Right Ventricle is dilated. 5. Moderate Tricuspid Regurgitation. 6. Severe pulmonary hypertension with calculated RVSP of 65mmHg +RAP. 7. Mild Mitral Regurgitation, 8. Trivial Aortic Regurgitation. 9. No LA/LV clot or pericardial effusion. NT Pro BNP not done. Pt started on conservative treatment.

38Y Male with breathlessness and pedal edema. Comment on CXR. will reveal past history in discussion.

33 week amenorrhea with sudden onset of severe breathlessness , EF 40,%, myocarditis , no CAD , no history of any comorbidity , BP 130/90, Pulse 120 , Respiratory rate 40 , gasping , intubated and shifted to icu On vent. please interpret the ABG. how to proceed

elderly patient with shortness of breath ' palpatation' dry cough ' ..ECG show LVH with Wide QRS...chest x ray as shown

75year old Male Ex smoker and Ex alcoholic c/o DOE *2months, loss of appetite, weakness sleepiness and palpitations o/e B. P 110/70,PR 115-120/min,SPo2-95% without O2 Chest B/L decreased air entry lower zones no Rohnchi P/A Soft and Non Tender Echo ECG Chest X-ray attached CBC TLC 16400,ESR 66 RFT normal Lft Normal pleural fluid send to lab for examination suggest diagnose and treatment