Abstract
38 years old patien male height176sm,weight81 kg was admitted to the ICU of RIC 03.05.2022 with ACS Cor muffled heart sounds, blood pressure of 150,160/110 mm Hg,Ps110 120 beat/min, rhythmic ECG sinus rhythm,p mitrale,moderate positive T wave in V1 two phase T wave in V2 and negative T wave in I V3 V6. TroponinI level 01ng/ml (ref.0 0,3) 04.05.2022 and 0,14ng/ml 05.05.2022. Laboratory tests 04.05.2022 lab.test revealed decreased WBC4,21x10^3/ml, significantly decreased LYM 0,62x10^3/ml,LYM#%14,8%,increased NEUT%76,8%,slitghtly decreased MON#10^3/ml. RBC increased slightly 6,07x10^6/ml, increased RDWCV% 16,4%,MCV decreased72,9fL,MCH23,1pg decreased. PLT was significantly decreased 94x10^3/mL,P LSR was incresed47,3%. CREATININE was high 2,92 mg/dl,urea increased level 79,18 mg/dl,BUN37 mg/dl,AST non significantly slightly increased 55IU/L 04.05.2022. ECHOKG 05.05.2022 LVIDd66 mm,LVIDs53 mm,LVPW12 mm. LVEF35%Left ventricle wall motion abnormalities, diffuse hypo kinesis. Doppler EXOKG Mitral regurgitation II. 06.05.2022. Ultrasound examination no any abnormalities, only left kidney size 128 x 50 was 8 mm longer than normal length. Because of two negative results of troponin I (ACS was excluded) and result of ECHOKG patient transfered to Heart failure department with diagnosis:DCM,Hypertension. Despite of creatinin level of .2,92 mg/dl, previously administered carvedilol 6,125 mg was substitute to ramipril 5 mg/day because of high blood pressure 150/90 mm.Hg. 07.05.2022, TM2441,A&D Company Ambulatory Blood Pressure Monitoring Device were used in this patient. Monitoring revealed non dipping,.despite of daytime systolic and diastolic blood pressure was in normal range, (5)Awake BP: Sleep BP SYS(> 135 mmHg) 0,00% SYS(> 120 mmHg) 16,67% DIA(> 85 mmHg) 16,67% DIA(> 70 mmHg) 83,33% (6) Circadian Rhythm:SBP drop at night 2,27% DBP drop at night 4,73% . Ambulatory blood pressure monitoring by TM 2141 allowed to suspect significant epizodes of arrhythmia. Dissemination of big number of signs of indicators of arrhythmia (IHB and Pulse error) during the monitoring pointed on serious rhythm disorders. After these findings 10.05.2022 Holter ECG were used in this patient.22 hours 26 min ECG monitoring revealed 2 episodes of VT,33 duplet PVC and 434 monomorphic PVC on background on atrial fibrillation. No any episodes of sinus rhythm were revealed. MRTno CHD,no infiltration 18,05.2022 repeat 24 hours ECG monitoring were performed in this patient. Result: During of 23 hours and 47 min.sinus rhythm were observed. No any epizodes of ventricle tachycardia,PVC or SVC were revealed.19.05.2022 6MWT perfomed on discharge day. Result: Patient overcome 420 meters.no any dispnia at stop. BP before start140/97 mm.Hg,PS73 b/min,BP at stop157/98 mm/Hg,PS77b/min, On comparison to previous 6MWT result (performed 11,05.2022) patient walked 47,4meters more. Patient was discharged from hospital 19.05.2022 with diagnosis: Dilated cardiomyopathy (DCM) Heart Failure NYHA III fc,EF33%,VT,AF,Hypertension stage II,high risk,CKD MDRD stage III. 25.05.2022 NTproBNP2608,9pg/ml,Vit D 13,21ng/dl,Ca9 mg/dl,Cr2,21 mg/dl,DImer500ng/ml,Hb11,8 g/dl
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