80F with HFrEF secondary to CAD

 80 year old female came with the chief complaints of sob since 3 days, pedal edema since 1 month and decreased urine output

HOPI

Patient was apparently asymptomatic 3 days back, then she had SOB which is grade II insidious in onset, gradually progressive and progressed to grade IV today morning. orthopnea + , no PND, pedal edema + which is pitting type

fever + low grade yesterday which is relieved by medication.

PAST ILLNESS

known case of CKD, hypertension and DM II since 15 years

known case of CAD 1 month back. Advised PTCA but was not done

TREATMENT HISTORY

Linagliptin 5mg OD

Amlodipine 5mg OD

On cefpodoxime 200mg BD

PERSONAL HISTORY

Married

Housewife

Normak appetite

Vegetarian diet

Rrgular bowel movement 

Decreased micturition

Teetotaler

GENERAL EXAMINATION

no signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy

Oedema of feet + 

Vitals:

Temperature : 98.2

PR : 116/ min

RR : 20/ min

BP : 130/70 mmHg

Spo2 : 83% at room air

Grbs : 144mg%

SYSTEMIC EXAMINATION

CVS : S1 S2 + , no thrills, no murmurs

RS : BAE + , NVBS

CNS : HMF intact, NFND


1-12-23












On 1-12-23
































On 3-12-23






On 4-12-23





DIAGNOSIS

Acute pulmonary edema secondary to heart failure
HFrEF secondary to CAD AWMI
with known case of diabetes and hypertension

TREATMENT
1. T. Ecosprin 325 mg stat dose given
2. T. Clopidogrel 300mg stat dose given
3. T. Atorvas 80 mg stat dose given 
4. Fluid restriction <1.5 L/day
5. Salt resttriction <2gm / day
6. Inj lasix (infusion) 8mg/hr IV 
7. Inj Heparin 5000 IU QID IV
8. T. Amlodipin 5mg PO/OD
9. T. Metxl 12.5mg PO/OD









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