CASE NO 2:

1
CASE NO 2 PRELIMINARY DATA NAME Mrs. XYZ
AGE 55 yrs.
SEX Female ADDRESS
Bhopoli INTRODUCTION A 55 yr old female
referred from bhopoli rural hospital came Into
the screening Opd with C/O difficulty in
breathing and Swelling over the lower
extremities.
2
HISTORY Since 2 yrs the pt complained of
gradual onset of breathlessness which increased
on exertion and walking for a short
distance. Eventually she developed Dyspnoea on
rest and Orthopnea. She had to take rest
intermittently while walking and was better on
sitting and lying on either Sides.
3
Onset duration and progress of complaint
since 1yr pt developed edema over the face and
lower extremities and breathlessness increased at
full moon and new moon. Since 1 month there was
increased frequency of urination with occ.
burning dysuria.
Feverish feeling lt evening, with profound
weakness, giddiness, and black outs in front of
the eyes. App decreased since 1month. No H /o wt
loss, chest pain, cough.
4

Examination finding
T 98 .F , P 84/ min ,BP 150/80 mm hg,
Pallor, bilateral pedal edema RS Trachea
deviated. Bilateral basal crepts P/A soft. L21/2
fp, S np. CVS Systolic murmur with P2 split .
JVP not raised. On Percussion Enlarged cardiac
dullness.
5
INDICATIONS FOR ADMISSION

• Clinical Monitoring
• Investigation of cause of symptoms
• Anticipation of life threatening complications
• Observing Remedy response in patient with
• Low susceptibilty and structural changes in
• vital organs

6
INVESTIGATIONS
7
BLOOD
CBC
ANEMIA
Hb 7.0 , TLC 6200, N62 L32 M2 E4.
LFT Alb 3.4, Glob 2.5 , SGOT 53, SGPT
56.7,
RBS 82mg/dl
8
kidneys
Urine routine Proteins , Pus- 2-3/hpf,
S. Urea 12.9, S. Creat 2.8, RBS 82mg/dl
SONOGRAPHY
BILATERAL CONTRACTED ECOGENIC KIDNEYS WITH LOSS
OF CORTICOMEDULARY DIFFERENTIATION S/O CHRONIC
MEDICAL RENAL DISEASE.
9
HEART
X-ray chest Cardiomegaly
ECG Left Ventricular Hypertrophy, anterior and
lateral wall myocardial ischemia
2D Echo Dilated cardiomyopathy with severe LV
systolic dysfunction LVEF 15
10
DIAGNOSIS
CONGESTIVE CARDIAC FAILURE DIALATED
CARDIMYOPATHY MYOCARDIAL ISHCEMIA ANAEMIA
CHRONIC RENAL FAILURE
11
No characteristic symptoms
Pathological Symptoms
Low susceptibility
Calc .Ars 30 c Single dose
Pace of the disease slow
Pathology Structural irreversible
Sensitivity LOW
Anemia Nephritis with albuminuria Dropsy heart
disease in
BOGERS approach
12
Materia Medica

• CRATEAGUS 4. STROPHANTHUS
• CONVELLARIA 5. LYCOPUS
• ADONIS 6. LAUROCERASUS

13
THE DIFFERNTIATING POINTS WERE 1. CRATEAGUS
A/F Rheumatic disease. Dropsy from
anemia. Hypertension, Arteriosclerosis Heart
Failure Dyspnea lt exertion Pallor, Anasarca. 2.
CONVELLARIA Absence of compensatory
hypertrophy. Anasarca, Orthopneagt lying
down Scanty Urine, Anuria
14
4. STROPHANTHUS Heart Failure , Dropsy lt
alcohol, lt exertion. Anemia Polyuria,
Albuminuria Arteriosclerosis 5. ADONIS
Arrythmia, fatty ht, rheumatic dis following
Brights disease Albuminuria, Scanty Urine.
Dropsy. Acts well as a Diuretic. 3.LYCOPUS Dec
reased ht rate, Increase length of systole.

15
Learning from case

• Importance of clinic o pathological co relations
• Role of investigation in diagnosis
• Importance of susceptibility in accessing potency
• Bogers approach