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Prema Venugopal,57yrs/F 11/11/11

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Provisional Diagnosis-Seroneg RA+Sec OA knees SHTN RHD/Severe MS/MR/Mild AR/Normal RV & lv fn Cholelithiasis
Final Diagnosis-Seroneg RA+Sec OA knees SHTN RHD/Mod Severe MS/MR/Mild AR/Normal RV & lv fn Cholelithiasis
History and Findings-Chr Allergic Br/Br Asthma from age 14yrs Rheumatoid arthritis x 17yrs (1994) on Ayurvedic Rx,Allopathy Rx last 7yrs Mild MS (AML & PML thickenning-subvalvar pathology not on Rx).SHTN x 14yrs,Echo 14/10/11-mild pericardial effusion,cataract surgery BE (May 2010 & June 2011) DOE class III x 1yr.Pain,swelling,stiffness-knees,shoulders & IP joints ++,Bluish nails,BP-130/80,Gr 2/6 ESm at LCV,PA,P2 loud,TR murmur+ JVP++
Investigation-Hb-12.7,ESR-28,HBA1c-5.5%,BU-24.8,Creatinine-0.8,A/g-4.16/2.6g,LDH-350,CRP-3.8,RA& ASO Neg,ECG-Poor R V1 V2,P.Pulmonal,Cxr-Rt base pleural blunting,P.Smear-N,USG abd-N,Xray knees-advanced OA b/l,Podiatrics-Severe P.Neuropathy,Low ABIndex,PFT-Mixed pattern dysfn,Echo-7/12/11-RHD/Thickened AML & PML,Moderate-severe MS,MVA 1-1.1cm2,Calcified MV,Mild AR,CT chest HRCT-8/12/11-Rt sided minimal pleural effusion,Cholelithiasis,No ILD,No L.adenopathy,B/l Venous & arterial doppler lower limbs-normal,BNP-825.5pg/ml (high).Echo TEE cardiology on 16/12/11-Mod severe MS & MR,thickened AV,Mild AR,Biventricular function-good
Treatment-Lanoxin/Amifru/Predmet 2mg/Oncotrex 7.5mg/wkly/Folvite/Telma/Lefra/Renerve/Dilzem/Udiliv /Cartilamine & Glucosamine
Follow Up-Adv:Cardiology f/u & ortho consultation
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doctor bhaskaaran

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