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 3months
Tab.ROSVAS 10mg since 3 months 

PERSONAL HISTORY:
Diet - mixed 
Appetite - Decreased 
Bowel - Regular
Micturition - Normal 
No know Drug allergy 
Alcoholic consumes 90ml/day , stopped 5 yrs back
Smokes Beedi 1pack/day, stopped 5 yrs back
No h/o Drug addiction 

FAMILY HISTORY : 
No H/o Diabetes, Hypertension , TB, Asthma, Epilepsy , CAD , Thyroid disorders in his family 

DRUG HISTORY :
No know Drug Allergy 

PROVISIONAL DIAGNOSIS :
ATRIAL FLUTTER WITH VARIABLE BLOCK,
HEART FAILURE WITH REDUCED EJECTION FRACTION (38%)
PRE RENAL AKI ON CKD-CARDIO RENAL SYNDROME -II.
K/C/O. VALVULAR ATRIAL FIBRILLATION WIR FVR 2'ry TO CHRONIC RHEUMATIC HEART DISEASE WITH MODERATE MR since 5yrs
COPD 
DENOVO DIABETES MELLITUS 

ON EXAMINATION 12/11/2024 , 8am
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-58/min , irregularly irregular 
HR - 160/min
Apex pulse deficit - 80
BP- 80/60mm of hg
RR - 28cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+,NVBS
PA -soft , non tender
CNS - NFND



INVESTIGATIONS : ON 12/11/2024
ECG ON 12/11/2024 at 7.30pm

CHEST X.RAY PA ON 12/11/2024

LAB REPORTS ON 12/11/2024

TREATMENT ON 12/11/2024 at 7.30pm

inj.LASIX 40mg iv.stat
INJ.PIPTAZ 4.5 gm IV.STAT
INJ.CLINDAMYCIN 600mg.IV.STAT
INJ.PAN 40mg IV .STAT
INJ.HEPARIN 5000 IU SC.STAT
TAB.MET.XL 25mg.po.STAT
NEB with IPRAVENT and BUDECORT 8th hrly.

ON EXAMINATION 13/11/2024 , 8am
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-78/min
HR - 170/min
Apex pulse deficit - 80
BP- 80/60mm of hg
RR - 28cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+,NVBS
PA -soft , non tender
CNS - NFND


ECG ON 13/11/2024 at 7.30am

LAB REPORTS ON 13/11/2024

TREATMENT ON 13/11/2024 8am :
Cnntinuous CPAP.
IVF- NS @30ml/hr
INJ.PIPTAZ 2.25gm IV.TID
CAP.DOXY 100mg.PO.BD
INJ.PAN.40mg.IV.OD
INJ.LASIX.40mg.IV.TID
TAB.DIGOXIN 0.25mg.OD( on alternate day)
TAB.CARDARONE 200mg.PO.TID
TAB.MET.XL 50mg.PO.BD
NEB - IPRAVENT, BUDECORT 6th hrly

ON EXAMINATION ON 14/11/2024 8am :
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-76/min
HR - 128/min (irregularly irregular)
Apex pulse deficit - 52
BP- 90/60mm of hg
RR - 28cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+ rhonchi +in,Left .ica,ima,diffuse crepts present 
PA -soft , non tender
CNS - NFND



ECG ON 14/11/2024at 7.30 am
CHEST X.RAY PA ON 14/11/2024

LAB REPORTS ON 14/11/2024
2D ECHO DONE ON 14/11/2024
TREATMENT ON 14/11/2024 8am : 
Cnntinuous CPAP.
IVF- NS @50ml/hr
INJ.PIPTAZ 2.25gm IV.TID
CAP.DOXY 100mg.PO.BD
INJ.PAN.40mg.IV.OD
INJ.LASIX.40mg.IV.TID
TAB.DIGOXIN 0.25mg.OD( on alternate day)
TAB.CARDARONE 200mg.PO.TID
TAB.MET.XL 50mg.PO.BD
NEB - IPRAVENT, BUDECORT 6th hrly

ON EXAMINATION ON 15/11/2024, 8am
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-72/min
HR - 110/min (irregularly irregular)
Apex pulse deficit - 38
BP- 100/70mm of hg
RR - 22 cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+ rhonchi +in,Left .ica,ima,diffuse crepts present 
PA -soft , non tender
CNS - NFND

TREATMENT ON 14/11/2024 at 8 am
Cnntinuous CPAP.
IVF- NS @50ml/hr
INJ.PIPTAZ 2.25gm IV.TID
CAP.DOXY 100mg.PO.BD
INJ.PAN.40mg.IV.OD
INJ.LASIX.40mg.IV.TID
TAB.DIGOXIN 0.25mg.OD( on alternate day)
TAB.CARDARONE 200mg.PO.TID
TAB.MET.XL 50mg.PO.BD
NEB - IPRAVENT, BUDECORT 6th hrly

ON EXAMINATION ON 15/11/2024 at 8am
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-68/min
HR - 110/min (irregularly irregular)
Apex pulse deficit - 42
BP- 100/70mm of hg
RR - 20 cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+ rhonchi +in,B/L.ica,ima,
PA -soft , non tender
CNS - NFND

TREATMENT ON 15/11/2024 ,8am
Cnntinuous CPAP.
IVF- NS @50ml/hr
INJ.PIPTAZ 2.25gm IV.TID
CAP.DOXY 100mg.PO.BD
INJ.PAN.40mg.IV.OD
INJ.LASIX.40mg.IV.TID
TAB.DIGOXIN 0.25mg.OD( on alternate day)
TAB.CARDARONE 200mg.PO.TID
TAB.MET.XL 50mg.PO.BD
Tab.SITAGLIPTIN 50mg PO.OD
NEB - IPRAVENT, BUDECORT 6th hrly

ON EXAMINATION ON 16/11/2024 at 8am
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-68/min
HR - 110/min (irregularly irregular)
Apex pulse deficit - 42
BP- 100/70mm of hg
RR - 20 cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+ rhonchi +in,B/L.ica,ima,
PA -soft , non tender
CNS - NFND
ECG ON 16/11/2024  7.30am
LAB REPORTS ON 16/11/2024,8am




TREATMENT ON 16/11/2024 ,8am
Cnntinuous CPAP.
IVF- NS @50ml/hr
INJ.PIPTAZ 2.25gm IV.TID
CAP.DOXY 100mg.PO.BD
INJ.PAN.40mg.IV.OD
INJ.LASIX.40mg.IV.TID
TAB.DIGOXIN 0.25mg.OD( on alternate day)
TAB.CARDARONE 200mg.PO.TID
TAB.MET.XL 50mg.PO.BD
Tab.SITAGLIPTIN 50mg PO.OD
NEB - IPRAVENT, BUDECORT 6th hrly

ON EXAMINATION ON 17/11/2024 at 8am
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-68/min
HR - 118/min (irregularly irregular)
Apex pulse deficit - 50
BP- 90/60mm of hg
RR - 20 cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+ rhonchi +in,B/L.ica,ima,
PA -soft , non tender
CNS - NFND
ECG ON 17/11/2024,7.30am
LAB REPORTS ON 17/11/2024,8am




TREATMENT ON 17/11/2024 ,8am
Cnntinuous CPAP.
IVF- NS @50ml/hr
TAB.AUGMENTIN 625 PO.TID
CAP.DOXY 100mg.PO.BD
INJ.PAN.40mg.IV.OD
INJ.LASIX.40mg.IV.TID
TAB.DIGOXIN 0.25mg.OD( on alternate day)
TAB.CARDARONE 200mg.PO.TID
TAB.MET.XL 50mg.PO.BD
Tab.SITAGLIPTIN 50mg PO.OD
SYP.LUPITUSS 10ml.PO.TID
NEB - IPRAVENT, BUDECORT 6th hrly

ON EXAMINATION ON 18/11/2024 at 8am
No pallor,No icterus , No cynosis , No clubbing , No lympedenopathy , Pedal edema (gr lll pitting type) present 
JVP - NOT RAISED 
APEX BEAT - left 5th ics , mid clavicular line

PR-84/min
HR - 100/min (irregularly irregular)
Apex pulse deficit - 16
BP- 100/80mm of hg
RR - 17 cpm
SPO2 - 96%at RA
CVS -S1S2+ ,no murmurs 
RS - BAE+ NVBS
PA -soft , non tender
CNS - NFND

TREATMENT ON 18/11/2024 ,8am

TAB.DYTOR PLUS(10/50) PO.OD
TAB.DYTOR 10mg PO OD
TAB.DIGOXIN 0.25mg.OD( on alternate day)
TAB.CARDARONE 200mg.PO.TID
TAB.MET.XL 50mg.PO.BD
Tab.SITAGLIPTIN 50mg PO.OD
TAB.DAPAGLIFZOLIN 5mg.PO.OD
TAB.NEPHROSAVE.PO.BD
SYP.LUPITUSS 10ml.PO.TID
NEB - IPRAVENT, BUDECORT 6th hrly

PATIENT DISCHARGED ON 18/11/2024.

     
Discharge Type: Relieved
Admission Date: 12/11/2024 06:45 PM   
Name of Treating Faculty
DR. RAKESH BISWAS DR. VAMSHI KRISHNA
Diagnosis
ATRIAL FLUTTER WITH VARIABLE BLOCK(RESOLVED)    >ATRIAL FIBRILLATION WITH FVR
HEART FAILURE WITH REDUCED EJECTION FRACTION (EF: 38%) PRERENAL AKI ON CKD CARDIORENAL SYNDROME II(RESOLVING) K/C/O VALVULAR ATRIAL FIBRILLATION WITH FVR SECONDARY TO
CHRONIC RHEUMATIC HEART DISEASE WITH MODERATE MS SINCE 5 YEARS COPD, DENOVO T2DM
Case History and Clinical Findings
CHIEF COMPLAINTS:
C/O FEVER 10 DAYS BACK, COUGH, BREATHLESSNESS SINCE 10 DAYS HOPI:
PT WAS APPARANTLY AYMPTOMATIC 10 DAYS BACK, THEN DEVELOPED FEVER, HIGH GRADE WITH CHILLS, LASTED FOR 1 DAY, DRY COUGH, BREATHLESSNESS GRADE 3 MMRC H/O DECREASED URINE OUTPUT FOR 1 DAY
H/O PEDAL EDEMA ON AND OFF, PALPITATIONS ON AND OFF NO H/O CHEST PAIN, ORTHOPNEA, PND
NO H/O PAIN ABDOMEN, VOMITINGS, LOOSE STOOLS H/O PLEURAL TAP 10 YEARS BACK.
PAST HISTORY:
K/C/O CRHD SINCE 5 YEARS WITH AF WITH FVR K/C/O HTN SINCE 3 YEARS AND IS ON MEDICATION
ISOSORBIDE DINITRATE 20 MG TWICE, SINCE 3 MONTHS
 

DILTIAZEM 90 MG SINCE 5 DAYS, STOPPED METXL 50 MG SINCE 5 DAYS LASIX 40 MG IN AFTERNOON SINCE 5 DAYS
EPLERENONE 25 MG SINCE 5 DAYS ( USED FOR 1 WEEK 2 MONTHS BACK) APIXABAN 5 MG SINCE 3 MONTHS
ROSUVAS 10 MG SINCE 3 MONTHS
N/K/C/O DM,THYROID DISORDERS ,EPILESY,TB.


PERSONAL HISTORY APPETITE NORMAL SLEEP ADEQUATE
BOWEL MOVEMENTS REGULAR BLADDER MOVEMENTS REGULAR
ADDICTIONS : ALCOHOL STOPPED 5 YRS AGO BEEDI STOPPED 5 YRS AGO .

FAMILY HISTORY NOT SIGNIFICANT


GENERAL EXAMINATION
PT IS CONSCIOUS COHERENT COOPERATIVE
NO PALLOR ICTERUS CYANOSIS CLUBBINGLYMPHADENOPATHY PEDAL EDEMA VITALS:
TEMPERATURE AFEBRILE BP 100/70 MMHG
PR 85 BPM
RR 18 CPM SPO2 98%AT RA

SYSTEMIC EXAMINATION CVS - S1S2 HEARD
PA - SOFT NON TENDER
CNS - NO FOCAL NEUROLOGICAL DEFICIT RS - BAE+ CREPTS + IN IAA, ISA
COURSE IN HOSPITAL:-
 

58 YEAR OLD MALE K/C/O CRHD WITH AF WITH FVR SINCE 5YEARS AND HYPERTENSION SINCE 3YEARS WAS BRUGHT TO CASUALTY WITH C/OFEVER, COUGH AND BREATHLESSNESS SINCE 10DAYS. VITALS AT ADMISSION BP-100/70MMHG, PR-52BPM,HR IN MONITOR-162,RR-18CPM, SPO2-96%@RA. ON AUSCULTATION CREPTS + DIFFUSELY IN ALL AREAS, TAB.METXL 25MG WAS GIVEN AND STARTED ON CPAP SUPPORT.ON FURTHER INVESTIGATION DIAGNOSED AS ATRIAL FLUTTER WITH VARIABLE BLOCK, HEART FAILURE WITH REDUCED EJECTION FRACTION (EF: 38%) PRERENAL AKI ON CKD- CARDIORENAL SYNDROME II, VALVULAR ATRIAL FIBRILLATION WITH FVR SECONDARY TO CHRONIC RHEUMATIC HEART DISEASE WITH MODERATE MS, COPD, DENOVO T2DM TREATED WITH CPAP SUPPORT, IV FLUIDS,DIURETICS, ANTIBIOTICS,MET-XL 50MG BD,CARDARONE 200MG TID AND NEBULIZATION AND OHAs. AT ADMISSION STARTED ON ANTICOAGULANTS BUT HEMATURIA WAS STARTED AND HENCE ANTICOAGULANT WAS STOPPED.HEART RATE WAS CONTROLLED AND BREATHLESSNESS SUBSIDED, NO FEVER SPIKES WERE PRESENT AND AKI WAS RESOLVED. PATIENT WAS IMPROVED CLINICALLY AND DISCHARGED IN HAEMODYNAMICALLY STABLE CONDITION.

Investigation
HBsAg-RAPID 12-11-2024 07:18:PM Negative
Anti HCV Antibodies - RAPID 12-11-2024 07:18:PM NEGATIVE KIT NAME : ALER TRUE LINE
HBsAg-RAPID Negative
HIV 1/2 Rapid Test Non Reactive FBS 164 mg/dl
HbA1c 7.3 % HAEMOGRAM 12/11/24:
HAEMOGLOBIN 13.3 gm/dl TOTAL COUNT 18,000 cells/cumm NEUTROPHILS 85 % LYMPHOCYTES 08 % EOSINOPHILS 01 % MONOCYTES 06 % BASOPHILS 00 % PCV 37.8 vol % M C V 84.6 fl M C H 29.6 pg M C H C 35.2 %RDW-CV 14.8 % RDW-SD 45.8 fl RBC COUNT 4.47
millions/cumm PLATELET COUNT 1.40 lakhs/cu.mm SMEARRBC Normocytic normochromic WBC With in normal limits PLATELETS Adeqaute HEMOPARASITES No hemoparasites seen IMPRESSION Normocytic normochromic blood picture with neutrophilic leukocytosis
LFT 13/11/24:
Total Bilurubin 1.66 mg/dl Direct Bilurubin 0.55 mg/dl SGOT(AST) 23 IU/L SGPT(ALT) 14 IU/L ALKALINE PHOSPHATASE 227 IU/L TOTAL PROTEINS 6.1 gm/dl ALBUMIN 3.2 gm/dl A/G RATIO 1.13
 

COMPLETE URINE EXAMINATION (CUE) 12-11-2024 07:18:PMCOLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN +SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4EPITHELIAL CELLS 2-3RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
BLOOD UREA 12-11-2024 07:18:PM 165 mg/dl SERUM CREATININE 12-11-2024 07:18:PM 3.6
mg/dl
SERUM ELECTROLYTES (Na, K, C l) 12-11-2024 07:18:PMSODIUM 131 mmol/L POTASSIUM 3.8
mmol/L CHLORIDE 99 mmol/L
ABG 12-11-2024 08:08:PMPH 7.41PCO2 28.1PO2 88.0HCO3 17.5St.HCO3 20.1BEB -5.2BEecf - 6.2TCO2 34.0O2 Sat 96.4O2 Count 20.0
TROPONIN-I 37.8 pg/ml
BLOOD UREA 13-11-2024 06:04:AM 180 mg/dl
SERUM CREATININE 13-11-2024 06:04:AM 3.6 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 13-11-2024 06:04:AMSODIUM 130 mmol/L POTASSIUM 3.6
mmol/LCHLORIDE 99 mmol/L HAEMOGRAM 13/11/24:
HAEMOGLOBIN 13.5 gm/dl TOTAL COUNT 15,500 cells/cummNEUTROPHILS 85
%LYMPHOCYTES 08 % EOSINOPHILS 02 % MONOCYTES 05 % BASOPHILS 00 % PCV 38.7 vol
% M C V 85.4 fl M C H 29.8 pgM C H C 34.9 % RDW-CV 15.1 %RDW-SD 47.1 flRBC COUNT 4.53
millions/cumm PLATELET COUNT 1.35 lakhs/cu.mm SMEARRBC Normocytic normochromic WBC neutrophilic leukocytosis PLATELETS mild thrombocytophenia HEMOPARASITES No hemoparasites seenIMPRESSION Normocytic normochromic blood picture with neutrophilic leukocytosis and mild thrombocytophenia
APTT TEST 31 Sec
Prothrombin Time 16 Sec INR 1.11
COMPLETE URINE EXAMINATION (CUE) 13-11-2024 07:49:AMCOLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++SUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4EPITHELIAL CELLS 2-3RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS NilBLOOD UREA 14-11- 2024 10:08:PM 174 mg/dl
SERUM CREATININE 14-11-2024 10:08:PM 3.3 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 14-11-2024 10:08:PMSODIUM 133 mmol/L POTASSIUM 3.5
mmol/L CHLORIDE 99 mmol/L HAEMOGRAM 14/11/24:
 

HAEMOGLOBIN 12.6 gm/dlTOTAL COUNT 15,900 cells/cumm NEUTROPHILS 85 %
LYMPHOCYTES 08 % EOSINOPHILS 02 %MONOCYTES 05 % BASOPHILS 00 % PCV 36.2 vol % M C V 85.6 fl M C H 29.8 pg M C H C 34.8 %RDW-CV 15.1 %RDW-SD 47.0 fl RBC COUNT 4.23
millions/cumm PLATELET COUNT 1.5 lakhs/cu.mm SMEARRBC Normocytic normochromic WBC neutrophilic leukocytosis PLATELETS Adeqaute HEMOPARASITES No hemoparasites seen IMPRESSION Normocytic normochromic blood picture with neutrophilic leukocytosis
Blood Urea 150 mg/dl 15/11/24 Serum Creatinine 3.0 mg/dl 15/11/24
SERUM ELECTROLYTES (Na, K, C l) 15-11-2024
SODIUM 136 mmol/LPOTASSIUM 3.5 mmol/L CHLORIDE 98 mmol/L CALCIUM IONIZED 0.99
mmol/L
HAEMOGRAM 15/11/24:
HAEMOGLOBIN 12.8 gm/dl TOTAL COUNT 15,500 cells/cumm NEUTROPHILS 85 % LYMPHOCYTES 09 % EOSINOPHILS 01 %MONOCYTES 05 % BASOPHILS 00 %PCV 37.5 vol % M C V 86.2 flM C H 29.4 pg M C H C 34.1 % RDW-CV 14.7 % RDW-SD 46.8 flRBC COUNT 4.35
millions/cumm PLATELET COUNT 1.56 lakhs/cu.mm SMEARRBC Normocytic normochromic WBC neutrophilic leukocytosis PLATELETS Adeqaute HEMOPARASITES No hemoparasites seen IMPRESSION Normocytic normochromic blood picture with neutrophilic leukocytosis
LFT 15/11/24:
Total Bilurubin 1.14 mg/dl Direct Bilurubin 0.20 mg/dl SGOT(AST) 10 IU/LSGPT(ALT) 14 IU/L ALKALINE PHOSPHATASE 128 IU/L TOTAL PROTEINS 5.2 gm/dlALBUMIN 2.6 gm/dl A/G RATIO 1.01
HbA1c 7.1 % 15/11/24
Blood Urea 139 mg/dl 16/11/24 Serum Creatinine 2.8 mg/dl 16/11/24
SERUM ELECTROLYTES (Na, K, C l) 16-11-2024
SODIUM 138 mmol/L POTASSIUM 3.3 mmol/L CHLORIDE 102 mmol/L CALCIUM IONIZED 1.03
mmol/L
HAEMOGRAM 16/11/24:
HAEMOGLOBIN 14.3 gm/dl TOTAL COUNT 18,400 cells/cumm NEUTROPHILS 85 % LYMPHOCYTES 09 % EOSINOPHILS 01 % MONOCYTES 05 %BASOPHILS 00 % PCV 41.5 vol
%M C V 86.8 flM C H 29.9 pgM C H C 34.5 % RDW-CV 14.8 % RDW-SD 46.6 flRBC COUNT 4.78
millions/cumm PLATELET COUNT 1.91 lakhs/cu.mmSMEARRBC Normocytic normochromic WBC With in normal limits PLATELETS Adeqaute HEMOPARASITES No hemoparasites seenIMPRESSION Normocytic normochromic blood picture with neutrophilic leukocytosis
2D ECHO BEDSIDE:
 

TACHYCARDIA DURING STUDY SINUS ARRYTHMIA
ALL CHAMBERS DILATED
RWMA LAD TERRITORY HYPOKINETIC, RCA AND LCX HYPOKINESIA (MILD LVH) MILD TO MODERATE MR(MR JET AREA 5.0CM2)
MILD AR
MODERATE TO SEVERE TR WITH MODE PAH IVC SIZE(2.08CM2) DILATED NON COLLAPSING CALCIFIED AV, THICKENED, MILD AS MODERATE MS
EF-38%, MODERATE LV DYSFUNCTIONAL NO PE/LV CLOT
USG ABDOMEN:
INCREASED ECHOGENICITY OF RIGHT KIDNEY LEFT KIDNEY GRADE-I RPD CHANGES

Treatment Given(Enter only Generic Name)
IV FLUIDS NS @50ML/HR CONTINOUS CPAP SUPPORT
INJ. PIPTAZ 2.25 GM IV/TID FOR 3DAYS INJ PAN 40 MG IV/OD
INJ LASIX 40 MG IV/TID
T. DOXYCYLINE 100MG PO/BD FOR 7DAYS T.AUGMENTIN 625MG PO/TID FOR 7DAYS
T. CARDARONE 200 MG PO/TID
T. METXL 50 MG PO/BD
T. DIGOXIN 0.5 MG PO STAT FOLLOWED BY 0.25MG ON ALTERNATE DAY T.SITAGLIPTIN 5OMG PO/OD
NEBULISATION WITH IPRAVENT 4 TH HRLY ANF BUDECORT 6 TH HRLY
Advice at Discharge
T.DYTOR PLUS 10/50 PO/BD AT 8AM T.DYTOR PLUS 10MG PO/OD AT 4PM
T. CARDARONE 200 MG PO/TID CONTINUE
T. METXL 50 MG PO/BD CONTINUE
 

T. DIGOXIN 0.25 MG PO/OD AT 8AM ON ALTERNATE DAYS T.SITAGLIPTIN 50MG PO/OD BEFORE BREAKFAST T.MONTEK-AB PO/BD X 1WEEK
T.NEPHROSAVE PO/BD X 15 DAYS T.REJUNEX CD3 PO/OD X 15 DAYS SYP.LUPITUSS 10ML PO/TID X 1 WEEK
FORACORT 200MCG MDI SPACER 2PUFS TWICE DAILY X 15 DAYS
Follow Up
REVIEW TO GM OPD AFTER 1 WEEK OR SOS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: 08682279999 For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language

SIGNATURE OF PATIENT /ATTENDER


SIGNATURE OF PG/INTERNEE


SIGNATURE OF ADMINISTRATOR


SIGNATURE OF FACULTY
Discharge Date Date: 17/11/24 Ward: ICU
Unit:II














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

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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, l
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