Child with generalised body swelling ,breath lessness,effort intolerence and head ache in pediatriconcall.com

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Question
9 year male child presented with generalized body swelling ,breathlessness,effort intolerance and head ache of acute onset.swelling started from lower limbs then to abdomen with breathlessness .there was no history of joint swelling,cough,decreased urine out put,no rashes,no loc either such previous ill ness in the past ,hospitalization,no medications.he was tachypnic,anasarca,pale,tachycardia, NO RADIO FEMORAL DELAY, all peripheral pulsations are feltgallop rhythem,wide fixed split second heart sound,grade 4 psm,with normal first sound,jvp was raised,tender hepato megaly with ascitis,there was basel creptations bilateraly.echo revealed ASD,USG-abdomen revealed non visulisation of right kidney which was conformed with CT abdomen,RFT ,LFT,ASO <200 ,serum electrolite revealed with in normal limit,irrespective of his improvement of theCCF he is persistent to have a BP of 190/140 mm hg,not responding to first line anti hyper tensive medication .what is the probable diagnosis,what further investigation should be carried out,which medication would you like to add on -------- The following values could not retrieve result :- which medication would you like to add on --------, what further investigation should be carried out, not responding to first line anti hyper tensive medication .what is the probable diagnosis, irrespective of his improvement of theCCF he is persistent to have a BP of 190/140 mm hg, serum electrolite revealed with in normal limit, ASO <200, LFT, RFT, USG-abdomen revealed non visualization of right kidney which was conformed with CT abdomen, there was basel creptations bilateraly.echo revealed ASD, tender hepato megaly with ascitis, jvp was raised, with normal first sound, grade 4 psm, wide fixed split second heart sound, all peripheral pulsations are feltgallop rhythm, NO RADIO FEMORAL DELAY, pale, anasarca, no medications.he was tachypnic, hospitalization, no loc either such previous illness in the past, no rashes, decreased urine out put
Answer
It may be hypertension induced cardiac failure. Rule out coarctation of aorta and aortoarteritis. A color doppler of abdominal as well as thoracic arota would be advisable. Also check blood pressure in all 4 limbs. If there is aortoarteritis, rule out autoimmune disorders. Control BP with nitroprusside or even nitroglycerine drip in ICU setting. Back to All Questions

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