60year MALE PATIENT WITH HEART FAILURE WITH REDUCED EF WITH AF

60year old male patient came with complants of
Difficulty in breathing since 10days
Palpitations since 10days
B/L pedal edema since 2months
Decreased urine out put since 2monts
Patient was apparently alright before 2 months gradually he devoloped decrease in urine out put, no burning micturition, no frequency, no urgency, no dribling of urine. 
Gradually he devoloped b/l pitting type of pedal edema which is grade-2 not associated with fever /trauma
He gradually devoloped shortness of breath which is grade-3, PND - present, ORTHOPNOEA - present  associated with PALPITATIONS, and weakness
No h/O  fever, cough, cold, vomitings, diarrhoea
Not a know case of Hypertension, Diabetes Mellitus, CAD, CVA 
Patient underwent inguinal hernioplasty 2 months back
Chonic Alcoholic stopped 2 months back
Chronic Smoking history present stopped 2 months back
ON EXAMINATION
patient Concious, coherant, cooperative 
No pallor
No icterus
No cynosis
No clbbing
No lmphedenopathy
Afebrile
Pulse=130 irregular, low volume
BP = 90/60 mm of hg
APEX - TAPPING APEX on palpation
CVS = Loud and Variable S1, Low piched Diastol Murmur with viable duration. 

RS = BAE present, NVBS present, no adventitious sounds
P/A = soft, non tender, no organo megaly 
SPO2, =98%at room air
GRBS =100gm/dl

PROVISIONAL DIAGNOSIS :
Heart failure with reduced ejection fraction (32%) 
Persistent Atrial fibrillation
Ischaemic cardio myopathy

INVESTIGATIONS:
HEMOGRAM 
Hb =13.1
Pcv =37.9
Tlc =12000
Rbc =13.7
Plt =2.27
RFT
Blood urea =24
Sr. Creatinine =0.9
Na =129
K=3.4
Cl=87
Inr =1.1
Aptt =3.2
 
PATIENT REVIEWED ON 26/02/2024 :

2D-ECHO( 26/02/2024) :
https://youtu.be/HT9QKiF1zCg?si=IO3RgCjIbjVekQxo


















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73 years old MALE PATIENT WITH PEDAL EDEMA, SOB WITH PARAXYSMAL AF

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73 old male patient came with Complints of Bilateral pitting type of pedal edema since 1 week Shortness of breath since 1year Decrease in appetite since 1year Palpitations since 1 year HOPI : Patient was apparently alright before 1week gradually he devoloped swelling of both the lower limbs , started initially in the foot and then in both the legs it is grade 2 pitting type of edema. No history of trauma, no history of fever, no history of decrease in urine out put.  SHORTNESS OF BREATH is  gradually progressive and is present even at rest  , PND present, ORTHOPNOEA present.  Decrease in appetite is associated with flatulence, dyspepsia, and constipation. No history of diarrhoea/vomitings/pain abdomen.  PAST HISTORY :  k/c/O Hypertension since 3 years on Tab. Amldipine  No history of DM/TB/ASTHAMA/EPILEPSY / CAD / SURGERY PERSONAL HISTORY : Smoker since 40 years smokes 2packs per day, stopped smoking since 1 year Chronic Alcoholic since 40 years drinks 90-180ml Ocasionally  No other ad
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