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Breathlessness, weight gain, history of chronic bronchitis and chain smoker. Swollen abdomen,enlarged liver, wheezing

Hi my name is stefan, I was wondering if someone would be able to help me with particular scenario i have and hopefully provide me with a process of diagnosis, DDX and final diagnosis. Thankyou for any help you can offer. 74 year old anxious retired caucasian electrician. Chief complaint- respiratory problems shortness of breath at rest. Up untill 3 months ago he enjoyed walking. But now he experiences brethlessness and has put on a lot of weight. long history of chronic bronchitis and chain smoker. vital signs- temp 36 degrees, BP 100/60, pulse 110, respirations 28 bpm. examination shows neck veins distended bilaterally, skin bluish at extremities and has to sit up to breathe easily. pitting oedema of extremities present bilaterally. Abdomen swollen and has ascites . liver enlarged. crackles and wheezes heard and a summation gallop was heard. ECG, Chest xray and Echo show right ventricular hypertrophy . lab results:increased haemoglobin , RBC, Haematocrit count, reticulocytes,monocytes and lymphocytes. PaCO2 is also high. Thankyou so much for any information you can assist me with.
Asked On : Thu, 5 Apr 2012
Answers:  1 Views:  64
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General & Family Physician 's  Response
Thank you for getting in touch with us. From what I make out, patient is in severe distress. In many people, lung problems over a span of time can lead to pulmonary hypertension and may then progress to heart failure. As this patients has distended neck veins, pitting edema of the extremities, enlarged liver, it can be safely said that this patient is progressing to right sided heart failure. Increased hemoglobin in this patient might be due to hypoxia caused by chronic bronchitis. Hypoxia over a period of time leads to increased production of erythropoietin by the kidney. Hope this helped.
Answered: Thu, 5 Apr 2012
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