A Case of Breathlessness & Chest Pain
*42 year old housewife reported to medicine emergency with history of dizziness followed by a syncopal episodes which she experienced while going to the washroom.
*It was accompanied by chest pain(progressive for 6 months, primarily on exertion, retrosternal, no radiation), produced swelling, breathlessness(for last 10 days& progressive in nature) & worse on lying down.
*cough with expectoration X 15 days
*Pedal edema on & off X 15 days
*Decreased Urine output X 15days
*She reported an episode of fever and joint pain during her childhood.
*Patient is from low socioeconomic background with no other CVS/respiratory risk factors.
# GPE= dizzy but we’ll oriented. Pulse 90/min, irregularly irregular, low volume with no radio-radial femoral delay, BP 80/60mm Hg, Resp Rate 28/min, Afebrile to touch but cold periphery.
# P+/I-/JVP raised/LAP-/Cy-/Cl-/PE+
# Respiratory System Examinati B/L air entry with fine basal carrots.
#CVS Examination: Variably loud sound S1, soft S2, a mid-diastolic rumbling murmur best heard over the mitreal area and an opening snap.
Abdomen = Soft/ non tender.
How to proceed further for diagnosis…?