Diagnosis and How to manage this?
Patient, 22Yr/M, with known case of valvular heart disease (severe MS(with AF), severe TR, severe pulm. HTN) came with c/o breathlessness for 1 day and palpitation for 1 day at casualty. He had been suffering from last year but he refused to take any medications as prescribed. He had a H/o taken native medicine last week. Now he was admitted in ICCU for his breathlessness and palpitation. ECG shows AF. Now he had vomited 3-5 episodes of coffee coloured content ( in the pic. ) No mass felt per abdomen and no tenderness. He was stable with bp 122/84 and pulse rate 82/min irregular. His LFT and RFT was elevated. He is now under lasix 40mg, kbind, carvedilol 6.25mg.
Simple upper GI endoscopy can be done to exclude upper GI causes though there is no mass or tenderness...
Actually it contains heart failure cells, macrophages containing hemosiderin..signs of lvf backward failure...pink frothy sputum for rupture of bronchopulmonary anastomosis