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