16

 Case History and Clinical Findings

62 YEAR OLD MALE Patient came with the complaints of pedal edema and scrotal swelling since 2 monthsshortness of

breath since 2 monthsPatient was apparently alright 1 year ago, then he developed weakness of right

upper and lower Limb and deviation of mouth to right side and started talking irrelevantlyMRI brain

imaging was done which showed infarcts.Pt. used allopathic as well as herbal medication and

weakness gradually improved by 6 months. patient has fluctuating sensorium since then which has

worsened since 2 months. complain of pedal edema and scrotal swelling since 2 months insidious

onset gradually progressive in nature up to nice fitting type continuous and nature know their regional

variation with shortness of breath with incidence in launching on set manually progressive signature

on ordinary activity great to grade 2orthopnea present pnd presentNot complain of chest pain,

palpitations ,fever vomiting loose stoolsPt is a known case of hypertension since 2 years (not on

medication. )Not a known case of DM TB asthma SEIZURES thyroid disorders.

GENERAL EXAMINATION:

PATIENT IS CONSIOUS, COHERENT AND COOPERATIVE

NO PALLOR, ICTERUS,CLUBBING, CYNOSIS, LYMPADENOPATHY VITALS:

BP:130/80MMHG

PR: 74BPM

RR:18CPM

SPO2:96%'

GRBS :164 MG%

SYSTEMIC EXAMINATION:

CVS S1, S2+ NO MURMURS HEARD

RS: BAE+ ,CREPTS PRESENT IN RIGHT IAA

P/A: SOFT NON TENDER

CNS:NFND

PT. CAME WITH THE ABOVE MENTIONED COMPLAINTS, THOROUGH CLINICAL EXAMINATION

AND LABORATORY INVESTIGATIONS WERE DONE

BLOOD AND URINE WERE SENT.

2 D ECHO - EF 35%

MODERATE TR WITH PAH , MODERATE MR, MODERATE AR

RWMA + , NO AS/MS ,SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION

PT IS DIAGNOSED WITH HEART FAILURE WITH REDUCED EJECTION FRACTION . PT. WAS

STARTED ON PRE-LOAD AND AFTER LOAD REDUCING DRUGS.

PT. 10 KGS LOST 10KGS AND PEDAL EDEMA AND SHORTNESS OF BREADTH

SUBSIDEDPSYCHIATRY REFFERAL WAS DONE I/V/O AGGRESIVE BEHAVIOUR SINCE 1 YEAR

AND WAS DIAGNOSED WITH 1.ORGANIC PERSONALITY DISORDER 2. TOBACCO

DEPENDANCE SYNDROME AND WAS ADVISED TAB. DIVLPROATE SODIUM 250MG BD, TAB.

LORAZEPAM 1MG , NICOTINE LOZENGES 2MG PO/SOS.

PT. IMPROVED SYMPTOMATICALLY DURING THE STAY IN THE HOSPITAL PT. IS BEING

DISCHARED IN HEMODYNAMICALLY STABLE CONDITION

Investigation

USG ABDOMEN - GROSS ASCITIS

B/L GRADE 1 RPD CHANGES B/L PLEURAL EFFUSION [R>L]

INCREASED WALL THICKNESS OF GALL BLADDER

SUBCUTANEOUS EDEMA IN THE ANTERIOR ABDOMINAL WALL

2 D ECHO - EF 35%

MODERATE TR WITH PAH , MODERATE MR, MODERATE AR

RWMA + , NO AS/MS ,SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION

FBS - 103 MG/DL

RFT :

UREA- 24

CREATININE-1.0

SODIUM-137

POTASSIUM-4.2

CHLORIDE-101

HEMOGRAM :

HB - 9.6

TLC - 5200

PLC -1.95

CUE :

SUGAR NIL

ALBUMIN NIL

PUS CELLS 2-4

EC 2-3

Diagnosis HEART FAILURE WITH REDUCED EJECTION FRACTION [EF = 37%] WITH ANASARCA WITH K/C/O HYPETENSION SINCE 2 YEARS WITH H/O CVA [ LEFT SIDED HEMIPARESIS] 14 YEARS AGO. WITHBORGANIC PERSONALITY DISORDER WITH TOBACCO DEPENDENCY SYNDROME

Advice at Discharge

FLUID RESTRICTION <1.5L/DAYSALT RESTRICTION <2G/DAYINJ. LASIX 40 IV/BDT. MET-XL

12.5 MG PO/ODT. ECOSPRIN AV 75 MG PO/ODT. TELMA 20MG/PO/ODT. EMPAGLIFOCIN 100

ML PO/ODTAB. DIVALPROATE SODIUM 250MG PO/ BDTAB. LORAZEPAM 1

MGPO/ODNICOTINE LOSENZES PO/SOS