Here is my transcription and interpretation of both pages of this General Case Sheet from Atal Institute of Medical Super Specialities, Shimla (H.P.):
Page 1 - History
Institution: Atal Institute of Medical Super Specialities, Shimla-171 012 (H.P.)
Document: General Case Sheet
Patient Name: Kripa Ram | S/o | M/P (likely Male Patient)
CR No.: 9215126002 / 19074 (partially legible)
Chief Complaints with Duration:
- Swelling (×1) | ×7m (7 months) | ×2m (2 months)
History of Present Illness:
- c/o ④ SOB (Shortness of Breath - grade 4)
- Palpitation | at today
- HR: 100/min
- BP: 104/24 mmHg (likely 104/74 or similar)
- SpO₂: 78% RA (Room Air) - severely low
- Hb: 16 g/dL (or possibly 16 g%)
- ④ SOB: only on moderate exertion (worsening)
- Past History of Illness, Surgical Operation/Intervention, Injuries:
- Dizzy + ew + sitting ④ | ortho ④ | L/o ④
- ④ Palpitation at exertion + sitting | Signs ④ | Lung ④
- AFL ④ (Atrial Flutter?)
- c/c ④ | Rest + up | Fever ④ | Cough ④ | Swelling (Bu k ④) | Distalgram ④
- History of any Drug or other Allergies: -④ (None)
- Family History: -④ (None)
- Personal, Occupational and Social History:
- Bloody sputum ④
- Lao | mdao | steward
- Sterol | on
- Bladder & bowel habits normal
- Married | on
- S/o ×3×
Page 2 - Examination
General Physical Examination:
- ½ | 9÷:1. | o× | wr | c | 0 (Likely: Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, Edema - standard GPE findings)
Per Abdominal & Per Rectal Examination:
- o ④ (No organomegaly)
- v.1
- V.PO
Local Examination: (blank)
Examination of Cardiovascular System:
- S₁S₂ ④ (Heart sounds normal)
- 2B÷: S₁, 1/3 A
- 4↑ | 3B÷ B/o ½ A (murmur details)
Examination of Respiratory System:
- c×>
- S₁ but mitt
- S₂ Bilateral the R₂O/L (bilateral findings)
- (b)l÷ (bilateral)
Nervous System:
- P× ④ at 4×
- (normal power/reflexes suggested)
Musculo-skeletal System:
- P× ④ | DLSB ④ (no deformity/limitation)
Endocrinal System:
- (partially illegible)
Clinical Summary (Interpretation)
This appears to be a middle-aged male patient (Kripa Ram) presenting with:
| Feature | Finding |
|---|---|
| Chief complaint | Swelling (7 months + 2 months) |
| SOB | Grade 4, now at rest/exertion |
| SpO₂ | 78% on room air (critically low) |
| Heart rate | ~100/min |
| Palpitation | Present |
| SpO₂/Hb | Hb 16 (likely polycythemia compensating hypoxia) |
| Past history | Atrial flutter (AFL?), orthopnea, exertional symptoms |
| Respiratory | Bilateral crepitations/findings |
| CVS | S1S2 heard, possible murmur |
Likely Differential Diagnoses to Consider:
- Congestive Heart Failure (CHF) - biventricular, given SOB + swelling + SpO₂ 78%
- Cor Pulmonale - given chronic hypoxia, high Hb (polycythemia), bilateral respiratory findings
- Valvular Heart Disease (murmur noted)
- Atrial Flutter with hemodynamic compromise
Note: The handwriting is difficult to read in several areas (typical of clinical case sheets). Some interpretations above are best estimates. A clinician reviewing the original document would have fuller context. Critically low SpO₂ of 78% on room air is a serious finding requiring urgent evaluation.This is an Echocardiography (2D Echo + Doppler) report from Atal Institute of Medical Super Specialities, Shimla. Here is the full transcription and interpretation:
Echocardiography Report - Transcription
AORTIC VALVE:
Morphology: Normal / thickening / calcification / restricted opening / doming / Flutter / Vegetation / Bicuspid / Tricuspid (circled)
Doppler:
- Aortic stenosis: Absent (circled) / Mild / Moderate / Severe — mmHg MG: ......... — Incomplete Sync (written)
- Aortic flow Vel: ......... m/sec, gradient of .........
- Aortic Regurgitation: Absent / Trivial / Mild (circled) / Moderate / Severe — DEC. Slope: ........ m/sec | IDG: ......... mm Hg
- PHT: ......... m/sec, ARJH: ......... mm LVOT: ......... mm
TRICUSPID VALVE:
Morphology: Normal / artesian / thickening / calcification / prolapsed / doming
Doppler:
- Tricuspid stenosis: Present / Absent (Present circled)
- EDG: ......... mm/Hg MDG: .........
- TAPSE: 1.7 cm (reduced - indicates RV dysfunction)
- Tricuspid Regurgitation: Absent / Trivial / Mild (circled) / Moderate / Severe — cm²
- TRJA: ......... cm² | RAA: .........
- TR Velocity: 3.1 m/sec
- TR Gradient: 38 mmHg
PULMONARY VALVE:
Morphology: Normal / Atresia / Thickening / Doming
Doppler:
- Pulmonary stenosis: Absent (circled) / Mild / Moderate / Severe — mmHg MDG: ......... Acc. Time: 9! ms
- PSG: ......... mm/Hg
- Pulmonary Flow Velocity: 0.7 m/sec, Gradient: ......... mmHg
- Pulmonary Regurgitation: Absent (circled) / Trivial / Mild / Moderate / Severe — mm Hg
- Early Diastolic Gradient: ......... mmHg; End. Diastol. Gradient: C ......... mm
- Expiration: ......... mm
- 2D IVC inspiration: ......... mm — >50% resp variation (written)
2D Findings (Free Text):
| Structure | Finding |
|---|---|
| LA | Enlarged |
| LV | Normal size |
| Rheum | Septal motion abnormality → Global LV HK (hypokinesia) |
| No significant Rhuma. Con LV4 | |
| No LA / LAA clot | |
| RA / RV | Normal size |
| Normal RV contraction | |
| IAS / IVS | Intact |
| No WPH (no wall perfusion? or no RWMA) |
FINAL DIAGNOSIS (Echo Conclusion):
RHD - Severe MS / Mod MR Mod AR Mild TR / PAH, Good LV Mild LVSD (N) RV* (Normal RV)
(Signed by reporting physician)
Clinical Interpretation
| Finding | Significance |
|---|---|
| Severe Mitral Stenosis (MS) | LA enlarged, rheumatic morphology, dominant lesion |
| Moderate Mitral Regurgitation (MR) | Combined MS+MR = severe rheumatic mitral disease |
| Moderate Aortic Regurgitation (AR) | Multi-valve RHD involvement |
| Mild Tricuspid Regurgitation (TR) | TR velocity 3.1 m/sec → estimated RVSP ~38 + RAP mmHg |
| PAH (Pulmonary Arterial Hypertension) | TR gradient 38 mmHg confirms pulmonary hypertension |
| TAPSE 1.7 cm | Borderline RV function (normal >1.7) |
| Mild LVSD | Mild left ventricular systolic dysfunction |
| LA Enlarged | Secondary to long-standing MS |
| No LA/LAA thrombus | Important - no clot in left atrium |
| IVC >50% variation | Suggests low/normal right atrial pressure |
Overall Summary
This patient (Kripa Ram from Pages 1-2) has Rheumatic Heart Disease (RHD) with:
- Severe Mitral Stenosis + Moderate Mitral Regurgitation as the dominant lesion
- Moderate Aortic Regurgitation - multi-valve disease
- Secondary Pulmonary Arterial Hypertension (TR gradient 38 mmHg → RVSP ~48-53 mmHg)
- Mild LV systolic dysfunction
- Left Atrial enlargement without thrombus
- SpO₂ 78% on room air (from case sheet) now explained by severe MS + PAH causing severe pulmonary congestion
This patient likely needs cardiology evaluation for balloon mitral valvuloplasty (BMV) or surgical valve repair/replacement depending on valve anatomy, given the severe MS with PAH.
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