Heart Disease in Pregnancy. .pptx

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1. CASE PRESENTATION HEART DISEASE IN PREGNANCY SUYASH SINGH IX Term Armed Forces Medical College, Pune

2. Mrs XYZ 24 year old Resident of Kondhwa Occupation: Home Maker Educated till Class X Informant Self; Reliability Good PATIENT PARTICULARS HUSBAND Mr XYZ 27 yr Old Occupation: Autodriver Socio Economic Status: Low Socioeconomic Status (Modified Kuppuswamy scale) Married since 01 year

3. Blood Group: B+ LMP: 07 July, 2020 EDD: 14 April, 2021 POG: 10 weeks, 03 days Primigravida G 1 P A L

4. Amenorrhoea x 2months UPT positive She has reported for her first antenatal visit and is currently asymptomatic. CHIEF COMPLAINTS

5. 1 st trimester Spontaneous conception; diagnosed by UPT USG: Confirmed SLIUF; corresponding to the POG of 10wk Routine ANC investigations have been advised; reports awaited She has been taking pre- conceptional Folic acid History of present pregnancy

6. No h/o excessive vomiting, fever with rashes No h/o bleeding PV or discharge PV No h/o pain abdomen No h/o burning micturition , increased frequency of micturition No history of radiation or teratogenic drug exposure No h/o chest pain, breathlessness, syncope, fatigue, palpitations, orthopnea , PND, pedal edema

7. Age of menarche: 13 years Past cycles: Regular, 28-30days - followed by 3-4 days of menses Not associated with dysmenorrhea or passage of clots Menstrual history

8. Married since 01 year Non-consanguineous marriage Obstetric Score: G 1 P L A Primigravida, currently at 10wk 3 days POG Obstetric History

9. 12 years of age: admitted to hospital for fever with severe joint pains: Initially the wrist joints were involved followed by knee joints and ankles X 03 days. Associated with redness and decreased mobility Preceded by an episode of sore throat and low grade fever(abrupt onset, non progressive, remittent pattern, relieved by medications) Not associated with any skin rashes It was treated with a course of antibiotics at a local hospital She has since been on secondary prophylaxis: Inj PENIDURE IM-every 3 weeks No other major medical or surgical illnesses in the past PAST HISTORY

10. No history of diabetes, hypertension, asthma, tuberculosis, heart diseases in the family No h/o children with congenital malformations No h/o twinning in family Family history

11. Diet: Mixed Calories required =2,500 kcals Calories intake = 2,100kcals Calorie Deficit = 18% Appetite : Good Sleep : sound and adequate Bowel and bladder : regular No h/o any substance abuse, Smoking, alcohol intake or high risk behaviour No h/o any known drug allergy Personal history

12. 24 year old primigravida , G 1 P A L , at 10 week 03 days period of gestation; spontaneous conception, with a past history of Acute Rheumatic Fever, currently on monthly Benzathine Penicillin secondary prophylaxis, presented for routine ANC visit and currently asymptomatic. SUMMARY

13. Patient is conscious, co-operative and well oriented to time , place and person Vitals : Patient is afebrile Pulse rate : 90 Beats/min in right radial artery which is regular in rhythm, good volume , normal in character, no vessel wall thickening, equal on both sides , no radioradial or radiofemoral delay and all the peripheral pulses were palpable General Physical Examination

14. BP: 110/70 mmHg in both arms in sitting position Respiratory rate : 16 breaths /min JVP: not raised(2.5cm above sternal angle) Mild Pallor present , No Icterus , Clubbing, Cyanosis, Lymphadenopathy , Pedal Edema BMI : 24.14kg/m 2 Height : 155cms Weight : 58kgs (Pre-pregnancy weight) Gait: Normal

15. Orodental hygiene well maintained; and no signs of nutritional deficiencies No dilated veins over the neck Thyroid appears normal Breast- normal, no retracted or cracked nipples and no palpable lump No stigmata/evidence of fresh rheumatic activity/ infective endocarditis .

16. CNS Examination: No Focal Neurological Deficits Respiratory System Examination: Bilaterally equal air entry, Vesicular breath sounds in all areas of lung, no adventitious sounds Systemic examination

17. Inspection: No chest wall deformities noted, No scars Visible apex impulse in medial to mid- clavicular line Palpation: Apex Beat-5 th Intercostal space; just medial to the mid- clavicular line, tapping in nature No parasternal heave/ thrills palpated Cardiovascular Examination

18. Percussion: Dullness on the apex Auscultation: S1+S2 audible S1 louder than S2 P2 is loud Mid-diastolic murmur in mitral area, Grade 2, increased on expiration and decreased on inspiration, Pres-systolic accentuation present Opening Snap present No abnormal sounds heard in any other region

19. Inspection: no visible lesions , incisional scars, Linea nigra , stria gravidarum , sinuses, stria gravidarum No visible pulsations Umbilicus is midline, not everted Hernial orifices are intact Abdominal examination

20. Palpation: Soft, non-tender, Uterus not palpable No palpable masses, hepatosplenomegaly Percussion: No horseshoe dullness/ ascites Auscultation: Bowel sounds- present, normoactive in all four quadrants No bruits heard

21. SUMMARY 24 year old Primigravida , G 1 P A L , at 10 wk 03 days period of gestation; spontaneous conception, with a past history of Acute Rheumatic Fever, currently on monthly Benzathine Penicillin secondary prophylaxis, presented for routine ANC visit and currently asymptomatic. On examination, mild pallor was seen, and a mid-diastolic murmur with opening snap and presystolic accentuation was heard, suggestive of mitral stenosis ; RHD NYHA- Grade 1.

22. A 24 years old lady is G 1 P L A at 10 weeks 3 days of gestation, presented for ANC, with examination findings suggestive of Rheumatic Heart Disease, NYHA Grade 1. Provisional diagnosis