heart failure case
A 44 year old male patient it came to casualty with C/o shortness of breath (grade II) according to NYHA classification Not associated with orthopnea/PND. C/o B/L PEDAL EDEMA ( pitting type ) since 1 week C/o decreased URINE OUTPUT since 1 week C/o FACIAL PUFFINESS since 1 week Pt was apparently asymptomatic 1 week back then developed fever associated with chills and rigor, was diagnosed with typhoid and was treated outside in a private hospital Pt also C/o loss of appetite, and 2 episodes of vomiting ( non bilious , non projectile ) not A/W nausea. Pt is a K/C/O -CKD since 10 years on regular medication - DM since 4-5 years (on GLIMI M2 and GLIMI M1) -HTN since 1 year - on Tab TELMA-AM NO SIGNIFICANT FAMILY HISTORY PERSONAL HISTORY O/E- Pt is c/c/c obese TEMP+98.4°F BP-130/80MMHG PR-89 BPM RR- 20CPM SPO2-98% @ RA CVS-S1S2 HEARD NO MURMUR RS-NVBS + NO CRYPTS P/A-SOFT, NON TENDER CNS-HMF INTACT APEX BEAT- 6TH ICS LATERAL AND OUTWARD JVP-RAI...