60 M acute coronary hypotension

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I am presenting a case of 60 year old man who came to the OPD with 

 

Chief complaints :- 

Abdominal pain since 10 days

History of presenting illness :- 

The patient was apparently asymptomatic 10 days ago then he developed abdominal pain which is dull aching type, non radiating, no aggravating and relieving factors.

The patient also has a history of hematuria which subsided now and poor stream of urine.

No h/o - vomiting 

No h/o - fever and chills

No h/o - trauma

Pod 0 patient developed hypotension and genral medicine referral was taken and patient was diagnosed ?nstemi an ECG showed t wave inversion AVL lead1 v 5,V6  Pt was admitted in ICU .

After admission in ICU  the patient was started started on dobutamine (6ml/hr) on 26/08/23 and on 27/08/23 noradrenaline(5ml/hr) was also given along with dobutamine (2ml/hr) later that day dobutamine was discontinued and on 28/08/23 the patient was only on noradrenaline (3ml/hr) . On 29/08/23 the patient was discontinued of noradrenaline and dobutamine was started (3ml/hr) . On 30/08/23 the patient was still on dobutamine (2ml / hr ).

Past history -

K/c/o - DM  since 2 yrs ( on medication METFORMIN - 500 mg PO / OD ).

N/k/c/o HTN / BA / epilepsy .

Surgical history - 

Surgery was done on July 2022 for bilateral ureteric calculus and bladder calculus ( URSL + cystolithotripsy + Dj stenting) .

Personal history :- 

Diet :- Mixed 

Appetite :- normal

Sleep :- Adequate 

Bowel and bladder :- regular

No addictions 

No drug or food allergies.

General examination :-  

Patient was concious coherent cooperative .

Moderately build and nourished.

Pallor- present

Icterus - absent 

Cyanosis - absent 

Clubbing - absent 

Lymphadenopathy - absent 

Edema- absent

Vitals :- 

Temperature – Afebrile ( 98.6 F )

Pulse rate – 65 bpm , regular 

Respiratory rate – 16 cpm

BP - 90/70 mmhg 

Spo2 - 97 on room air 

GRBS - 180 mg / dl

SYSTEMIC EXAMINATION

CARDIOVASCULAR SYSTEM

INSPECTION :- 

Chest is elliptical shaped, bilaterally symmetrical.

Trachea appears to be central 

Movements are equal bilaterally.

No scars or sinuses

Apical impulse seen in 5th intercostal space lateral to midclavicular line.

PALPATION :- 

All the inspectory findings are confirmed 

Trachea is central 

Apical impulse felt at 5th intercostal space lateral to midclavicular line.

AUSCULTATION :- 

S1 S2 heard no murmurs .

RESPIRATORY SYSTEM 

INSPECTION :- 

Elliptical.

bilateral symmetrical.

Trachea is central 

Movements are equal bilaterally

Visible epigastric pulsations 

No scars or sinuses

Apical impulse not seen.

PALPATION :- 

All inspectory findings are confirmed: Trachea is central, movements equal bilaterally.

Apex beat felt in left 5 th intercoastal space.

PERCUSSION :- 

Resonant note heard in all areas bilaterally

AUSCULTATION:- 

Bilateral air entry present – Normal vesicular breath sounds heard.

PER ABDOMEN

INSPECTION 

Shape of abdomen appears to be Normal

No Visible epigatric veins

No engorged veins sinus scars

PALPATION 

All inspectory findings conformed

Abdomen soft & Non tender

No organomegaly

PERCUSSION 

Tympanic note heard all quadrants abdomen

AUSCULTATION

Bowel sounds heard.

CENTRAL NERVOUS SYSTEM :- 

HMF - Intact 

Speech – Normal 

Motor and sensory system – Normal 

Reflexes – Normal 

Cranial Nerves – Intact 

Gait – Normal

Cerebellum – Normal  

Clinical images :- 

Investigations :- 

On 24/08/23 :- 

On 25/08/23:- 

On 26/08/23 :- 

 

   At 1.00 am

  At 3.00am

  At 7.00am

On 27/08/23:- 

On 28/08/23

On 29/08/23 

On30/08/23