ventricular tachcardia

CASE PRESENTATION : 

CASE PRESENTATION DR. JAWED

BIODATA : 

BIODATA Age: 65 years Sex: male Address:

Presenting complaint : 

Presenting complaint Palpitation for one day

HISTORY OF PRESENTING ILLNESS : 

HISTORY OF PRESENTING ILLNESS 65 years old male present with history of palpitation for one day, intermittent, suddenly started last for about a minute, increase with exertion and decrease by rest, increase in frequency for the last hour before presenting to the hospital.

HISTORY OF PRESENTING ILLNESS : 

HISTORY OF PRESENTING ILLNESS No history of chest pain or dyspnea No history of fever No history of vomiting / sweating No history of sore throat or cough. No history of joint pain No history of insomnia No history of any unusual event at home or outside.

Review of systems : 

Review of systems No fatigue No weight loss GIT No diarrhea or constipation No hemetamesis or malena

Review of systems : 

Review of systems Respiratory system No cough / haemoptysis CNS No headache ;no blurring of vision No history of fits, no syncope Genitourinary No burning micturation No haematuria

MEDICAL HISTORY : 

MEDICAL HISTORY Known to have hypertension since 30 years. Known to have left ventricular dysfunction with chronic atrial fibrillation.

PAST HISTORY : 

PAST HISTORY No diabetes

Family History : 

Family History Died of heart problem cause not known

Personal history : 

Personal history Non smoker Her bowel habits are regular Appetite normal

DRUG HISTORY : 

DRUG HISTORY ENALAPRIL ASPIRIN WARFARIN

summary : 

summary 65 years old male known HTN, chronic atrial fibrillation with LV dysfunction presented with history of palpitation for one day

Differential diagnosis : 

Differential diagnosis Supra ventricular tachycardia Ventricular tachycardia Atrial fibrillation with fast ventricular rate

Examination : 

Examination Patient with average built and height, conscious and oriented, not in distress. Pulse:190b/m, irregular, BP: 100/60 mmHg Afebrile JVP not raised

Examination : 

Examination No anemia or jaundice No xanthelsema No Peripheral cyanosis No clubbing or splinter hemorrhage No carotid bruit No neck swelling

Examination : 

Examination No palpable lymph nodes No radio femoral delay No lower limb or sacral edema No rashes

Cardiovascular system : 

Cardiovascular system Apex beat displaced laterally at 6th mid clavicular line, non sustained No thrill S1 + S2

Slide 19: 

Respiratory system Chest moving equal bilaterally Clear to auscultation Gastrointestinal/CNS Unremarkable

summary : 

summary 65 years old male known HTN, LV dysfunction presented with history of palpitation for the last one day, examination shows pulse rate of 190 b/min, irregular and normal blood pressure.

Differential diagnosis : 

Differential diagnosis Supra ventricular tachycardia Ventricular tachycardia Atrial fibrillation with fast ventricular rate

ECHOCARDIOGRAM : 

ECHOCARDIOGRAM DIALATED LV AND GLOBAL HYPOKINESIA WITH IMPAIRED SYSTOLIC FUNCTION. EF 30% DIALATED BOTH ATRIA MILD MITRAL REGURGITAATION TRICUSPID REGURGITATION PAP 45 mmHg

Biochem and CBC : 

Biochem and CBC Na: 134 mmol/l K: 4.6 mmol/l Mg: .9 mmol/l Ca: 2.1 mmol/l Creatinine: 128 umol/l Hb: 10.6 g/dl Wbc: 4.7 thsd/cumm Platelets: 204 thsd/cumm

Final diagnosis : 

Final diagnosis VENTRICULAR TACHYCARDIA WITH LV DYSFUNCTION

Slide 29: 

A variety of definitions of NSVT have been published, favorable is the following: Three or more consecutive ventricular beats A rate of > 120 beats/min A duration of less than 30 seconds One clearly established premise is that NSVT in the presence of structural heart disease carries a more serious prognosis than NSVT in the absence of a myocardial abnormality.

Slide 37: 

Thank You !