1. Name :PUJAPPA
Age :14yrs
Sex :Male
Address:Marenali
Bagnur post ,yelanka ,Bangalore North.
Informant :Father ,Mother & self(reliable)
DOA:

2. No h/o cough, fever, chest indrawing
No h/o palpitation,edema of feet,decrease urine output.
No h/o headache,vomiting,convulsions,
weakness of limbs.

3. Past h/o:h/o URI 2-3 times /year
No h/o suggestive of ALRI
No h/o admission to hospital
Family h/o:non consanguineous marriage.

4. No h/o CHD
No h/o CHD

5. Birth h/o:unbooked & unimmunised
1—no h/o drug intake,fever with rash
2--- no h/o suggestive PIH,DM
home delivery conducted by untrained dai.
BCIAB avg wt baby.prelacteal feeds sugar water 2-3spoons .started breast feeding 2hr after birth till 5months.
No h/o intermittent feeds
No h/o sweating over forehead during feeding

6. No h/o fever ,cough, chest indrawing.
Immunisation h/o:
Unimmunised(unawareness)
Development h/o:appropriate for age.

7. NUTRITION H/o Required Getting deficit 2400 Kcal 1400 58% 70 gms 48
65%
Required
Getting
deficit
2400 Kcal
1400
58%
70 gms 48
65%
NUTRITION H/o

8. Socioeconomic h/o:Father 1st std ,Mother illiterate --coolie Rs 500/month.
1room 1kitchen kerosene stove cooking
out door sanitation.
low socioeconomic status

9. summary
14yr old male boy pujappa 5th child of non consanguineous marriage presented with
h/o breathlessness on exertion with squatting episodes since age of 3yrs.
h/o cyanosis
h/o not gaining wt.
no h/o repeated ALRI/CCF

10. CCHD with decrease pulmonary blood flow
TOF
TGV with VSD with PS
DORV with PS
Single ventricle with PS

11. ANTHROPOMETRY expected Wt 24kg (5th centile) 35kg
Ht 142cm(25th centile)150cm
HC 51cm
CC 57cm
Wt age
Ht age yrs weight more affected
Wt for ht than height
US/LS

12. VITALS PR -72/min regular, good volume,all
peripheral pulses well felt,no R-R,no
R-F delay
BP- 100/68mmhg—UL, 110/70 –LL.
RR-18/min
Temp –Afebrile
JVP--N

13. HEAD TO TOE EXAMINATION
Head –N
Eyes –conjunctival xerosis,conjunctival suffusion
Ears –N
Nose –N
Neck –no lymphadenopathy
Mouth – lips & tongue –cyanosis ,no caries
Hands –nails –cyanosis,clubbing –grade 3
Feet –toes-- cyanosis,clubbing –grade 3,no pedal edema
SMR –stage 2

14. Thorax & abdomen –Branding marks +
Skin –N
Bones & joints –N
Spine– N
No facial dysmorphism
No extracardiac markers
No features of infective endocarditis.

15. SYSTEMIC EXAMINATION PR-72/min BP-100/68-UL,110/70-LL JVP-N
Inspection :Apical impulse seen in 4th ICS
medial to MCL.
No precordial bulge
No other visible pulsations.

16. Palpation :Apical impulse seen in 4th ICS
0.5cm medial to MCL,Normal.
Thrill left 2,3,4 ICS along sternal border.
Parasternal heave grade 1
no epigastric pulsation,
no palpable P2
Percusion :left border corresponds to apex.

17. Auscultation :heart sounds S1 S2 heard
ejection systolic murmur of grade 4 heard best in left upper sternal border with diaphragm ,during inspiration,with sitting posture.
MA:S1S2+ same ejection systolic murmur +
PA : S1S2+, single S2,well heard , same ejection systolic murmur .
TA: S1S2+
AA:S1S2+

18. RS :Trachea central
B/L symmetrical chest movement+
B/L air entry
NVBS+
P/A:Soft
no organomegaly ,BS+
CNS:No focal neurological deficits.

19. Impression :CCHD with decreased pul blood flow in sinus rhythm, with out failure,
with no evidence of IE.
TOF
DORV with PS
TGV with VSD with PS

20. Investigations Hb :16.8 gm/dl PCV:58.8% TC-8,600cells/cumm
DC N-71% L-22% E-4% M-3%
RBC 7.55million/cumm
Platelet :2.23lac
PBS:normocytic normochromic

22. ECG:HR-72/min
regular rhythm
PR interval 0.16sec
QT interval 0.32 sec
Right axis deviation (+120)
RVH –Tall R wave in V1 &deep S wave in V6

23. Chest X-ray:
ECHO: