51F WITH CHB S/P PPI WITH INFLAMMATORY MYOCARDITIS

 

Diagnosis :

Syncope

 2:1 AV block / CHB

    Mild LV dysfunction

 S/P CPR (1 Cycle)

     S/P TPI [01.10.26]

     S/P Dual chamber PPI [04.10.26] Boston Scientific

     S/P FDG PET [12.10.26] S/o ? Granulomatous heart disease (under further evaluation)

     ? Subclinical Hypothyroidism

 

Past Medical History :

     Recent CAD : Unstable Angina

     Mild LV dysfunction

     LBBB

     S/P CAG [08.09.26] Normal coronaries

 

Chief Complaints :

Mrs xxxx aged 51 yrs old Female, presented with H/o syncope episodes since 1 month on and off (3 times a day initially), initially went to outside hospital, on evaluation Trop I - Positive, S/P CAG - Normal coronaries [08.09.26], again had C/o pedal edema since 15 days with SOB class III and syncope, went to outside hospital, was advised for Pacemaker, now got admitted here for further management.

 

General Examination :

       Patient Conscious / Coherent

       No Pallor , No Icterus , No Clubbing , No Edema , No Cynosis

       Pulse Rate : 50 / Min (irregular)

       Temperature : 98.4

       Blood Pressure : 130/70 mmHg

       Respiratory Rate : 20 / Min

       Saturation : 98 % On Room Air

 

Systemic Examination

     CVS [ S1 , S2 PRESENT ] , Resp. System [ BAE + ] , Abdomen [ SOFT, BS + ] , CNS [ NAD, GCS, 15 / 15 ]

 

Course In the Hospital :

Mrs xxxx aged 51 yrs old Female, got admitted with the above mentioned complaints to the hospital. ECG showed Sinus Rhythm, 2D Echo showed LV RWMA, Mild LV dysfunction, Grade I diastolic dysfuncton. She was treated with Diuretics, Heparin, statins and other supportive medications. Routine investigations done. HB – 14.5& CREAT – 0.9. Under strict aseptic condition, TPI placed [01.10.26]. CAG CD reviewed - Ostial LAD mild plque. Review Echo showed EF: 45%, Good RV function, IVC 1.9cm, collapsing < 50%, Mild PAH. In view of recurrent syncope symptoms, she was advised PPI. Pre procedure IV antibiotics and IV fluids were started. Procedure was done on 04.10.26. PPI Dual chamber Boston Scientific was implanted with aseptic precautions. Post procedure no bleeding and hematoma at suture site. IV antibiotics were switched to oral medications. Device checkup was done. There were no other post procedural complications noted during her hospital stay. As part of evaluation, FDG PET done S/o ? Granulomatous heart disease. It is under further evaluation. Patient was stable at the time of discharge. Long term prognosis was explained in detail.

 

 

Date	09-10- 2026 08:45	04-10- 2026 08:03	03-10- 2026 07:32	02-10- 2026 07:04	01-10- 2026 11:56	Units	Reference
Sodium	134*	141	143	144	146*	mmol/L	135 - 145
Potassium	4.5	4.1	2.9*	3.4*	3.4*	mmol/L	3.5 - 5.1
Calcium	1.22	1.11*	1.04*	1.19	1.23	mmol/L	1.13 - 1.32
Creatinine	0.90	0.90	0.90	1.0	0.90	mg/dl	0.6 - 1.2
Blood Urea	22	29	30	26	25	mg/dl	10 - 45
Egfr	77	77	68	77		ml/min/1.73 m2
Date	05-10- 2026 10:03	04-10- 2026 08:03	03-10- 2026 07:32			Units	Reference

Haemoglobin	14.5	13.7	13.4			g%	11 - 16
RBC Count	4.9	4.6	4.5			x10^6/ul	4 - 5.2
Total WBC Count	9600	12600*	15400*			cells/cumm	4000 - 11000
Platelet Count	2.57	2.52	2.86			Lakhs/cum m	1.5 - 4.5
Packed Cell Volume (PCV)	44.0	41.8	40.5			%	36 - 46
Mean Corpuscular Haemoglobin (MCV)	88.5	89.2	88.1			fl	70 - 100
Mean Corpuscular Heamoglobin(MCH)	29.2	29.3	29.1			pg	27 - 32
MeanCorpuscular Heamoglobin Concetration(MCHC)	33.0	32.8	33.0			g/dl	32 - 36
RDW	14.3*	14.6*	14.5*			%	11.6 - 14
Granulocytes	70	70	77*			%	40 - 75
Lymphocytes	25	25	18*			%	20 - 40
Eosinophils	03	02	02			%	0 - 6
Monocytes	02	03	03			%	2 - 10
Basophils	00	00	00			%	0 - 1
TSH	10.2					uIU/mL

 

 

2D Echo Report :

S/P PPI

PPI LEAD SEEN IN RA / RV

NORMAL SIZED CARDIAC CHAMBERS

LV RWMA+, HYPOKINETIC ANTERIOR SEGMENT FAIR LV SYSTOLIC FUNCTION (EF : 53%)

GOOD RV FUNCTION (TAPSV= 10.8Cm/s)

GRADE II ALTERED DIASTOLIC FUNCTION (E/E'= 16) NO MR / NO AR / TRIVIAL TR / NO PAH / NO PR

NO LV CLOT / NO PE

IVC NORMAL 1.2Cm COLLAPSING >50%

 

Discharge Medication

 

Order Date	Drug Name	Dose	Route	Frequency	Duration	Remark
13-10-2026 03:10 PM	TAB ATORVA 40MG	40 mg	ORAL	Once Daily(OD)	daily	9PM AFTER FOOD
13-10-2026 03:10 PM	TAB PAN 40MG	40 mg	ORAL	Once Daily(OD)	daily	7AM BEFORE BREAKFAST
13-10-2026 03:10 PM	TAB FEBUSTAT 40 MG	40 mg	ORAL	Once Daily(OD)	daily	8AM AFTER FOOD
13-10-2026 03:10 PM	TAB THYRONORM 25MCG	25 mcg	ORAL	Once Daily(OD)	daily	7AM BEFORE BREAKFAST
13-10-2026 03:10 PM	TAB DOLO 650MG	650 mg	ORAL	TID(THRICE DAILY)	For 3 days	8AM - 2PM - 8PM AFTER FOOD
13-10-2026 03:10 PM	TAB DYTOR PLUS 10/25 MG	1 Tab	ORAL	Once Daily(OD)	daily	8AM AFTER FOOD
13-10-2026 03:10 PM	CAP BECOSULE Z	1 Tab	ORAL	Once Daily(OD)	daily	2PM AFTER FOOD
13-10-2026 03:10 PM	SYRUP DUPHALAC	15 ml	ORAL	SOS	SOS	9PM AFTER FOOD, SOS IF CONSTIPATED

Condition at Discharge :

     Patient Conscious / Coherent

     No Pallor , No Icterus , No Clubbing , No Edema , No Cynosis

     Pulse Rate : 80 / Min

     Temperature : 98.4

     Blood Pressure : 130/70 mmHg

     Respiratory Rate : 20 / Min

     Saturation : 98 % On Room Air