23 yo female p/w one week h/o dyspnea with exertion and increasing lower extremity edema. Pt c/o intermittent episodes of atypical chest tightness and pressure that does not occur necessarily during rest or with exertion. Non-radiating. Does not occur with palpation, shortness of breath, nausea/vomtting or diaphoresis. Dyspnea not present at rest. Pt denies PND, fevers, cough or syncopal episodes. No recent long plane flights or car rides. Denies tobacco, alcohol or drugs. No recent changes in medication. Symptoms have been getting progressively worse over past one week. Pt now unable to climb stairs in apartment without resting mulitple times. Leg swelling is equal bilateral. No redness, warmth or pain. LMP one week ago. Her PE is significant for the following She is in NAD with normal vitals, well appearing, resting comfortably with mild b/l basilar crackles, no wheeze; has an audible murmer III/VI ASB and has b/l +1 pitting edema up to mid calf, no redness, warmth, negative homan’s sign. Below is her ECG. What is your diagnosis?
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Posted on 01/21/2010
A 15 month healthy female presents to the ED with 2 days of a fever running 104-105F responding to tylenol. After two days the patient becomes afebrile and develops nasal congestion and dry cough. Two days later, the patient develops a rash: not itchy, not tender, it is flat and red that blanches. The child is eating and drinking. She is wetting diapers like normal and having normal bowel movements. As you exam the rash, the child interacts with you appropriately. Once you are done, you note the child playing and drinking juice. What is your diagnosis and treatment?
