A 65 year old with orthopnea
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A 65 year old male who is a farmer by occupation resident of miryalaguda came to the casuality with
CHIEF COMPLAINTS:-
Chief complaints of shortness of breath and pedal edema since 15 days.
HISTORY OF PRESENTING ILLNESS:-
Patient was apparently asymptomatic 6 years back then he developed high grade fever associated with chills, rigor and cough.
Then he was diagnosed with Diabetes and hypertensiom.
No history of nausea ,vomitings and get treated by local RMP by injections ( injections unknown) (oral medication does not relieve the fever) .this type of fever used to reappear every 6-7 months ( not seasonal) and associated with similar symptoms .
Then 3 months 15 days back then he developed shortness of breath which is insidious in onset which increased on supine position. (orthopnea) after that they went to local hospital where he was referred to a higher centre where they have done coronary angiogram which showed proximal LAD 50 % ; OM 3 70 % stenosis and renal angiogram which showed BILATERAL RENAL ARTERY stenosis ( left 90% and right 50% )
Then PTCA was done to patient on 12/11/21 to OM 3 and PTRA to left renal artery.
Then Shortness of Breath was resolved.
After 2 months i.e., 15 days back he again developed shortness of breath ( orthopnea) and pedal edema which is pitting type and went to hospital on 2/2/22 and regular cbp was done which showed HB of 6 and 2 blood transfusions are done and the HB improved to 7.9 (5/2/22)
On 14/2/22 he presented to our hospital where they increased the dose of previous tablet and done investigations as follows:-
On 16/2 and 17/2 night the SOB(orthopnea) of the patient increased and came to our hospital where the condition of the patient deteriorated and was admitted in th ICU .
PAST HISTORY:-
Diabetic and hypertensive since 6 years
No thyroid,TB , Leprosy.
ALLERGIC HISTORY:-
No allergy to any kind of medication.
FAMILY HISTORY:-
No significant family history
DRUG HISTORY:-
Oral diabetic drugs ( name unknown dose unknown) ?
PERSONAL HISTORY:-
Diet :- normal
Appetite:- normal
B&B :- normal
Addictions :- smoking
GENERAL EXAMINATION:-
Patient is on mechanical ventilator. Unconscious.
Patent is unconscious
Pedal edema - positive(pitting)
No icterus ,no cyanosis, no clubbing no lymphadenopathy
Vitals:-
Temp:- afebrile
PR - 100 bpm
BP - 150 / 90 mm hg
SpO 2 g 70 %
GRBS - 126 gm%
SYSTEMIC EXAMINATION:-
CVS - S1 S2 heard
RS - BAE +, coarse creps + in all areas
P/A - soft, no tender
CNS - patient is drowsy, NAD
Patient is intubated on 18/02/2022
INVESTIGATIONS:-
On 18/02/2022
CBP:-
ECG:-
X- ray on 19/2/2022
CBP on 20/2/2022:-
X ray on 20/2/2022 :-
DIAGNOSIS:-
Acute left ventricular failure with severe LV dysfunction secondary to MI with pulmonary edema with HFrEF(EF = 35 %) with AKI on CKD.
TREATMENT:-
1. Inj. LASIX 40mg IV /TID
2. Inj OPTINEURON 1amp in 100ml NS IV /OD
3. INJ HYDROCORT 100mg IV /BD
4. Neb with duolin and budecort 6th hrly
5. RT feeds 200ml milk 4th hrly
6. Fluid restriction < 1.2 l/day
7. Salt restriction < 4gm /day
8. Strict i/o monitoring
9. Vitals monitoring hrly
10. Tab MET XL 50mg RT /OD
COURSE IN HOSPITAL:-
Patient heart suddenly stopped on the 19/02/2022 .CPR was done and patient heart beat started again.
Since the day of admission 2 times dialysis was done.
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