45 Years Male Smoker Presented With Breathlessness Cough Wheeze

A 45-year-old male smoker presented with cough Breathlessness wheeze having this kind of X-ray and ECG changes suggests Pulmonary Hypertension could be due to COPD as all thought. Thanks all, who got involved in this case. This is a very typical case of CHD Eisenmenger syndrome. X-ray is very typical water jug appearance due to dilatation of MPA and branches with peripheral pruning of vessels, right Atria, right Ventricle enlightenment. The x-ray revealed mild calcification of MPA right Lowe lobe bronchiectasis changes. ECG is unusual in spite of severe PAH, where PAH is made out by the only persistence of S wave upto V6.

Sometimes ECG can be misleading. Echo revealed large Subpulmonary VSD with Bidirectional shunt & severe PAH. HB 18 g due to Erythrocytosis. Had mild clubbing and cyanosis. Patient has been on Endothelin receptor antagonists Ambrisentan 5 mg of & sildenafil 20 mg bd and…