ABSTRACT
A 63 years old male patient was admitted with complaints of acute pain in abdomen and nausea since 1 day. He had no history of chest pain, palpitations, shortness of breath, orthopnoea, paroxysmal nocturnal dyspnoea. There was no history of constipation or obstipation, vomiting’s, haematuria, or oliguria. Patient had a past history of systemic hypertension, diabetes, IHD since last 8 years. He was non-smoker, non-alcoholic. On examination, he was mesomorphic, febrile, had pulse rate of 146 bpm, irregularly irregular, his blood pressure was 134 / 86 mmHg. He had bilateral pitting oedema feet and on abdominal examination, there was diffuse tenderness in all the quadrants of abdomen. Guarding or rigidity over the abdomen was absent.ECG was suggestive of atrial fibrillation with fast ventricular rate as shown in figure 1. Haemoglobin 12.8 gm per dL, WBC - 24,900 cells / cumm, CKMB - 6, Troponin I was negative, serum cholesterol - 95 mg / dL, serum triglycerides - 91 mg / dL, LDL - 63 mg / dL, VLDL - 18 mg / dL, HDL - 14 mg / dL, serum LDH - 382 U / L, CRP - raised, D - dimer was positive, CHA2DS2 - VASC score was 4 and HAS - BLED score was 3. In view of persistent acute pain in abdomen, he underwent CECT abdomen which was suggestive of hepatosplenomegaly with hyper dense liver with multiple splenic and renal infarcts as shown in figure 2. 2D ECHO findings were dilated cardiomyopathy with congestive cardiac failure (ischemic) with 40 % left ventricular ejection fraction. He underwent coronary angiography, which revealed ischemic heart disease.