Chest Infections |

Atypical Pneumonia in a Patient With CHF and COPD FREE TO VIEW

Nabaneeta Khattar, MBBS
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Sambhunath Pandit Hospital, Kolkata, India

Chest. 2014;145(3_MeetingAbstracts):122A. doi:10.1378/chest.1835228
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SESSION TITLE: Infectious Disease Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Introduction- 65 y o M with preexisting CHF, with Ejection fraction 30%, COPD on medicines ramipril - 2.5 mg/d, eplerenone - 25 mg, aspirin and clopidogrel 75 mg, cardace- 6.25 mg, atorvastatin - 10 mg, isosorbide mononitrate 20 mg and Lasix 40 mg.

CASE PRESENTATION: Patient had Acute MI suffered 14 years back with stenting ,pacemaker. Second time pacemaker in 2011. He has episodes pulmonary edema controlled with an increase in dose of furosemide temporarily and with antibiotics.For a month , there was work and family worries in excess, he got drenched in rain one morning, felt tired and weak but took a head shower. In evening, he had difficulty speaking words,trouble breathing. A high fever about 102 F that resolved with supportive management in a day. The following day patient started feeling better but only soon to have started with cough and chest pain with coughing on either side of his rib cage.Cough was mucoid, productive, with chest pain, difficulty lying flat, and trouble breathing at nighttime while sleep.

DISCUSSION: A course of amoxicillin and levofloxacin, steam inhalation was given to abate breathing problem. Then cough became nonproductive. Patient had difficulty lying flat, he slept in side lying posture with 3 pillows always. The cough became scant and frothy, he was a known case of CHF. It was decided that patient be started on furosemide dosage 60 mg on the first day, 40 mg on the second and 20 mg on the third day. He lost 3 kg the second day on diuretic, initially weighing 71 kg. Regular pulse, Blood Pressure and temperature charting was being done. The blood pressure fell in about 3-4 days of starting diuretics slowly every day About 3-4 days later patient started complaining on drenching sweats at about 5 am, felt weak,urine output decreased , feeling unsteady on his feet, his mouth started felt too dry, his blood pressure continued to drop. One of these days in the morning around 5 am, he was no more.

CONCLUSIONS: What was the case. Possible causes for patients death could be atypical pneumonia, right heart failure secondary to chronic heart failure with superimposed chest infection.

Reference #1: Nabaneeta Khattar

DISCLOSURE: The following authors have nothing to disclose: Nabaneeta Khattar

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