Discussant: Dr. Sama Rajashekhar

Presenter: An 18 years old female patient came with history of difficulty in breathing on exertion, initially New York Heart Association (NYHA) Functional Classification (FC) II for 6 months, progressed to NYHA FC III over the next 3 months. There was history of paroxysmal nocturnal dyspnea (PND) attacks and pedal edema for the last 2 months. Patient was taken to outside hospital where she was managed conservatively and symptoms improved. On presentation to our hospital she had shortness of breath (SOB) NYHA FC II.

She did not complain of chest pain, palpitations, abdominal distention, facial puffiness, reduced urine output, fever, generalized weakness, cough with or without expectoration, loss or gain in weight, skin rash, pain or swelling of joints, generalized anasarca, pain abdomen, constipation, diarrhea, melena, burning micturition, tingling numbness of limbs, and bleeding manifestations.

There were no similar complaints in the past. She takes both vegetarian and nonvegetarian diet. No history of consumption of alcohol or tobacco in any form. Having regular menstrual cycles. There was history of use of medication like diuretics, vasodilators, and β-blockers. None of the family members had any illness including cardiac disease.

Discussant: Clinical presentation of this 18 years old female, with exertional dyspnea, pedal edema, and PND attacks suggestive of decompensated heart failure (HF). The possible differential diagnoses are discussed below.

Publication Date:
15 February 2022 (online)

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