70year MALE PATIENT WITH HEART FAILURE WITH REDUCE EJECTION FRACTION, COPD, WITH SVT

Patient came with the complaints of cough non productive since 5 days and SOB since 5 days.

HOPI :- patient was apparently asymptomatic 5 days back then he developed cough insidious in onset non productive more at night time , aggravated on supine position.
C/o SOB grade 3 MMRC insidious in onset.
H/o orthopnea , chest pain,PND.
H/o cold, loss of appetite and loss of weight.
No h/o palpitations pedal edema.
No h/o fever, abdominal distension, facial puffiness.
No h/o sweating.

Past history:- 
K/c/o CAD  since 2 yrs not using any medication since 2 months.

N/K/C/O HTN DM Epilepsy asthma and thyroid disorders 

Addictions:- regular alcoholic stopped 7 months back.
Smoker stopped 1 year back.

General examination:- 
Patient is C/C/C
No pallor icterus cyanosis clubbing lymphadenopathy edema
Vitals at admission :- 
Temp - afebrile
PR -120bpm
BP- 130/90 mmhg
RR- 20 cpm

Systemic examination:- 
CVS - S1 S2 heared
RS - BAE + , NVBS.
CNS - NFND
P/A - soft non tender.

Usg done on 11/1/24 
Impression:- 
-RPD changes in bilateral kidneys.
- b/l renal cortical cystes 

2d echo :- 
EF - 35%,
Impression :- 
Eccentric MR+, moderate MR + , mild TR + with PAH , mild AR + .
RWMA + Rca hypokinetic , LAD hypokinesia,
Moderate to severe LV dysfunction
Diastolic dysfunction, no PE.

Provisional diagnosis:- HEART FAILURE WITH REDUCED EJECTION FRACTION (<35%).

FINAL DIAGNOSIS:- -HEART FAILURE WITH REDUCED EJECTION FRACTION (<35%),
-PSVT.

Treatement given :- 

Fluid restriction < 2 lit / day.
Salt restriction < 2 g / day.
Inj Lasix 20 mg IV TID if bp is less than 110 mmhg.
Inj Monocef 1 gm IV BD 
Inj adenosine 6mg iv stat followed by 
Inj Adenosine 6mg iv stat 
Inj hydrocort 100 mg IV stat
Tab pulmoclear BD 
 Tab digoxin 0.5 mg stat followed by 0.25 mg 
Tab ecospirin  AV 75/10 po hs 
Neb with ipravent 6 th hrly , budecort 12 th hrly.







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