Sunday, May 6, 2012


      It was my first patient. Normally I start at 1 pm . We however see new patients at 12-30  pm if they happened to be sick enough that they can't wait ,  but not sick enough to need to go to the emergency room . These are the patients that I 'squeeze' in at 12-30pm .
     She was 54 years old white female , who had or was in process of moving from other state. Her husband had moved here due to change in job and now she was trying to move after taking care of the 'stuff ' in her previous state. .When she was 'home ' she was driving on a highway and got chest pain and then developed a dry cough. She was also little short of breath. So she went to an emergency room . She was evaluated by the physician and had x-ray done , blood tests done and an EKG was also done . There was no 'heart attack ' , which was her concern as her father had died of heart attack, at very early age . The chest x-ray showed 'pneumonia ' So the emergency room physician gave her antibiotics and cough medicine and she was told to do the follow up with her private MD.
     She was quite busy, as her husband had moved , and she was trying to sell her house and so could not sees her own MD, but did manage to go to a 'walk in clinic ' . She still had the dry cough and still felt short of breath. She had no fever. The MD at the walk in clinic did again the blood tests , did another x-x-ray and told her that her 'pneumonia ' was still there and gave her different antibiotic and told her to do the follow up with her own MD.
     She was now in our state and city and was more short of breath and still had the cough . She now also had some sputum, which was clear and had no fever. She could not sleep well due to the cough and the shortness of  breath . She ended up in a walk in clinic and the doctor did another x-ray told her that her pneumonia was not clear , gave her yet a another antibiotic and told her to see a lung specialist.He gave her my name . Now she was in our office.and so due to such a long history we gave the 12-30 appointment. Today she was so short  of breath that she had to sit down for 5 minutes after taking the shower . She had brought with her the x-ray film and the blood tests.
    She looked quite comfortable , did not look short of the breath and did not look 'sick' . Her blood pressure was low normal , her oxygen saturation was 96 % and she all most sounded clear on the examination of the lungs except for mild crackles at the bases of the lungs. She did have a  murmur . When I asked her about it , she told me that she had a murmur and was told to have a prolapse mitral valve. I looked at her x-ray and told her that she did not have pneumonia . I also told her that I was concerned about the heart, and she may have a leaky valve, that may need urgent attention .I also told her that if this was not the case , then I would admit her to the hospital , do lung biopsy and start her on intravenous antibiotics. I was quite concerned about her overall status . Her 'pneumonia ' was going on for last 6 weeks . and she had not improved .
     She did not have the car and had come to my office in a cab . I called a cardiologist, who is my friend too . I told him the story and told him to see her ASAP. He agreed. I was so concerned that I told my office manager to drive her to his office .
    He called me in an hour , with the news that she had severely leaky mitral valve had needed to be admitted . She was stabilised , had a heart catheterizing and then was operated for the 'repair ' of the valve.
    So the so called pneumonia turned  out to not the unresolved pneumonia, but  congestive heart failure,. As her valve became leaky  the  blood instead of being pumped out , was going wrong way , causing congestion in the lungs . So the lungs which are like dry sponge, normally , were now like wet sponge and so she was short of breath .

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