A 28 year old female with no known co-morbids from Azad Kashmir in November, 2016 presented to us in General Surgery department of PIMS (Pakistan Institute of Medical Sciences), Islamabad; with a history of swelling in front of the neck for 3 years with worsening dyspnoea and orthopnoea
for one year.
She was asymptomatic and there was no history of chest pain, dyspnoea, orthopnoea
or any other complaint and her past history too was insignificant for everything except the miscarriage for which she was admitted.
position eases respiration and circulation in patients with heart and lung dysfunctions.
Pain in left arm, insomnia, increased sweating, pedal oedema and orthopnoea
were the less common presenting complaints.
peripheral oedema, orthopnoea
, paroxysmal nocturnal dyspnoea, raised jugular venous pressure, pulmonary oedema and/ or tender hepatomegaly) in the presence of clinical signs of cardiac dysfunction (i.e.
Other commonly reported symptoms are dyspnoea on exertion, orthopnoea
, headache, dizziness and visual changes.
There was no history of fever, sore throat, joint pain, orthopnoea
, palpitations, chest pain, haemoptysis, syncope, oliguria, rashes, and weight loss.
The symptoms had worsened significantly in the few days preceding admission and he complained of orthopnoea
and a persistent dry cough.
The major criteria were paroxysmal nocturnal dyspnoea, orthopnoea
, jugular venous distention, pulmonary rales, cardiomegaly, pulmonary edema, presence of a third heart sound, and weight loss of 4.5 kilograms in 5 days in response to diuretic therapy.
The three most common presenting signs and symptoms were dyspnea (97%; n = 958), basal lung crepitations (95%; n = 938), and orthopnoea
(73%; n = 723).
The typical symptoms of HF are breathlessness, orthopnoea
, paroxysmal nocturnal dyspnoea, reduced effort tolerance, fatigue, and ankle swelling.
 Large left atrial tumours impairing intracardiac blood flow can produce variable clinical features, from slowly progressive orthopnoea
and paroxysmal nocturnal dyspnoea, to acute pulmonary oedema, syncope or sudden death.