62M ,ACUTE ON CHRONIC LVF , HFREF (EF-30%) WITH PERMANENT AF WITH FVR , K/C/O. HYPERTENSION

C/o COUGH SINCE YESTERDAY 
SHORTNESS OF BREATH SINCE 10YRS
SWELLING OF BOTH THE LOWER LIMBS SINCE 3 MONTHS.

HOPI :
Patient was apparently asymptomatic day before yesterday then he developed insidious in onset associated with sputum mucoid in consistency , non blood stained, more at night and less during morning.
H/o. Shortness of breath since 10 years , insidious in onset and gradually progressive, which is of grade-lll NYHA , associated with palpitations.
H/O.B/L pitting type pedal edema grade-Ill , more towards evening and less in the evening .
No H/O fever, cough,cold , vomitings , diarrhoea, burning micturition 

PAST HISTORY :
K/C/O. Hypertension since 15 years 
K/C/O HFREF WITH ATRIAL FIBRILLATION since 10years.
No H/O . DM/TB/ASTHMA/EPILEPSY/THYROID DISORDERS .

TREATMENT HISTORY:
On Tab.GLIMI.M1 since 15 yrs
On Tab.MET.XL 12.5 mg since 10yrs
On Tab. LASIX 20mg since 10yrs
Tab.ECOSPRIN.AV since 10yrs.

PERSONAL HISTORY:
Diet - mixed 
Appetite - normal 
Bladder and Bowel - Regular 
Sleep - adequate 
Alcohol - Regular 90ml/day stopped 10 years back 
Smokes 1pack/day stopped 10 years back 
No drug addictions 

FAMILY HISTORY:
No H/O HTN/DM/TB/ASTHMA/EPILEPSY/CAD/THYROID DISORDERS in the family.

PROVISIONAL DIAGNOSIS :
ACUTE IN CHRONIC LVF , HEART FAILURE WITH REDUCED EJECTION FRACTION ( 30%) WI

GENERAL PHYSICAL EXAMINATION:
HEIGHT - 168 cms
WEIGHT - 62 kg
NO PALLOR 
NO ICTERUS 
NO CYNOSIS 
NO CLUBBING 
NO LYMPH EDNOPATHY 

DAY 1 ON EXAMINATION: 20/11/2024 at 6.45pm
TEMP - 98 f
PULSE - 100/min irregularly irregular.
HR - 132/min irregular heartbeat 
APEX PULSE DEFICIT - 32
BP - 100/50 mm of hg
RR - 32 / min
SPO2 - 95% on room air
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , B,/L BASAL CREPTS PRESENT 
PA - SOFT , NON TENDER 
CNS - NFND 





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