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58 YRS MALE , ATRIAL FLUTTER WITH VARIABLE BLOCK , HEART FAILURE WITH REDUCED EJECTION FRACTION ( 38%) PRE RENAL AKI ON CKD , K/C/O. VALVULAR AF WITH FVR ,SECONDARY TO CHRONIC RHEUMATIC HEART DIDEASE WITH MITRAL STENOSIS, K/C/O.COPD , DENOVO. HYPERTENSION.

58yr Old male patient complaints of FEVER since 10days, COUGH since 10days , SHORTNESS OF BREATH since 10days. HOPI:  Patient was apparently asymptomatic 10days back suddenly he had high grade fever associated with chills and rigors , relieved by medication  COUGH since 10 days non-productive associated with difficulty in breathing which is grdae-lll mmrc  and Decrease in urine output , , pedal edema on and off below knee pitting type more towards evening and less in early morning . No H/o.chest pain , No H/o. Palpitations , No H/o. Pnd / orthopnoea  PAST HISTORY:  Known case of HYPERTENSION since 5yrsk Known case of CRHD with AF ,FVR NO H/o.DM,TB, ASTHAMA, EPILEPSY, THYROID DISORDERS  TREATMENT HISTORY: He is on Tab.ISOSARBIDE DINITRATE 20mg BD since 3 months Tab.APAXIBAN 5mg since 3 months  Tab.ROSVAS 10mg since 3 months  Tab.Diltiazem 90mg since 5 days  Tab.Lasix since 5 days  Tab. Eplirenone 25mg since 5days Tab. APAXIBAN 5mg since 3...
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76 years old MALE WITH CARDIOGENIC SHOCK, ATRIAL FIBRILLATION, HFREF (17%) PRE RENAL AKI ON CKD, RIGHR UPPER LOAB FIBROSIS (post TB sequelae)

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76 years old MALE patient came with complaints of DIFFICULTY IN BREATHING since 1 month HOPI :  Patient was apparently alright before 1 month then he devoloped DIFFICULTY IN BREATHING insidious in onset and gradually progressive from grade -1 to grade -2 then to grade -4 (mmrc)  No h/o cough No h/o chest pain, chest tightness  No h/o sweating / giddiness No h/o vomitings /diarrhoea No h/o bleeding manifestations PAST HISTORY : K/C/O PULMONARY TUBERCULOSIS took medication for 6 months 2years ago and also took the same medication for 6 months 4 years ago. Not a K/C/O HTN /DM / ASTHAMA /EPILEPSY/CAD PERSONAL HISTORY : Diet - mixed,  Appetite -decreased Bladder - Normal Bowel - constipation ADDICTIONS : Regular Alcoholic took 1 bottle of toddy/day since 40years , stopped 2 months ago Smokes 4-6 chuttas /day since 40 years, stopped 2  months ago.  FAMILY HISTORY : No history of similar complaints in the family.  No history of DM/HTN/TB/ASTHAMA/EPILEPSY/CAD ...
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84 MALE , COMMUNITY ACQUIRED PNEUMONIA , TYPE- ll RESPIRATORY FAILURE, PARAXYSMAL AF WITH FVR , HFMEF (EF-45,%) , K/C/O.BRONCHIAL ASTHAMA

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PRESENTING COMPLAINTS: 84 YEARS MALE PATIENT C/O.SHORTNESS OF BREATH SINCE MORNING  FEVER SINCE 5 DAYS.  HISTORY OF PRESENTING COMPLAINTS : The patient was apparently asymptomatic before  3yrs gradually he had shortness of breath on and off, which is of GRADE -ll NYHA and sinc morning he had sudden onset of severe shortness of breath associated with minimal exertion.  fever since  5 days associated with chills and rigor intermittent and High grade .   Cough with sputum since 5days whitish in colour, copious in amount. PAST HISTORY: NO H/O. HYPERTENSION  NO H/O. DIABETES MELLITUS  NO H/O. CAD /CVA  NO H/O. TB/ ASTHMA / EPILEPSY  TREATMENT HISTORY: NO PREVIOUS HISTORY OF MEDICATIONS  PERSONAL HISTORY:  Diet - mixed  Appetite - normal  Bladder and Bowel - Regular  Sleep - adequate  Alcohol - Regular 90ml/day since 20yrs Smokes 1pack/day since 20yrs  No drug addictions  FAM...
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