49 yrs old male with HF and CKD

 Chief complaints

Right lower limb swelling since 10 days, fever since 5 days


History of presenting illness

Patient was apparently asymptomatic 10 years back then he developed progressive swelling of right lower limb and diagnosed with filariasis for which he was prescribed medicines by a local doctor

10 year back he was diagnosed with diabetes mellitus and hypertension and since then using antihypertensives( nifedipine) and anti diabetics( glizide)

- 3 years back he developed pedal oedema and went for further evaluation and diagnosed to have chronic renal failure ?

- 2 years back he suffered from COVID-19 following which he had shortness of breath at rest (grade 4) and chest pain for which he went to co-operate hospital in Hyderabad and diagnosed to have inferior wall myocardial infarction, So he was treated with streptokinase. At that time coronary angiogram was not done in the view of high serum creatinine levels

- After 1 month cononory angiogram was done to recanalized the right coronary artery, later he had many episodes of SOB(grade 4) and diagnosed with severe heart failure and hydralazine four times a day

- since 10 days they is swelling of Right lower limb with no local rise of temperature and fever since 5 days


Daily routine



Wakes up at 5am 


walking for 1hour


breakfast - 7.30


Goes to work- 8am


1pm - lunch


4.30pm- tea


6pm - home


8pm - dinner




. - Used to have Alcohol- occasionally but stopped since 4 years 




Past history

Hypertension and diabetes since 10 years and was medications

No history of fever

No history of vomiting 

No history of loose stools

No history of past surgeries


Treatment history


antihypertensives( nifedipine) and anti diabetics( glizide)

-coronary angiogram for re canalisation 


Personal history

Occupation is house contractor

Sleep is adequate

Diet is mixed

bladder is normal

No allergies

Occasionally  


Family history 

Not significant 


General examination


Patient is conscious, coherent and co-operative.


Examined in a well lit room.


Moderately built and nourished



Icterus - absent



Pedal edema - present 


pallor is present            


 No cyanosis, clubbing , lymphadenopathy .




Vitals :


Temperature- afebrile


Respiratory rate - 20 cpm


Pulse rate - 110 bpm 


BP - 130/80 mm Hg.


Spo2 at room air is 85% on admission 


GRBS - 146 mg%






SYSTEMIC EXAMIN ATION: 




CVS : S1 S2 heard, no murmurs


Respiratory system : normal vesicular breath sounds heard.




Abdominal examination: 


INSPECTION : 


      Shape of abdomen- obese


-No tenderness of abdomen 


Umblicus - normal

Movements of abdominal wall - moves with respiration 

Skin is smooth and shiny;

No scars, sinuses, distended veins, striae


PALPATION : 


No Local rise of temperature


Tenderness absent


Rigidity absent 


hernial orifices normal


Fluid thrill absent


Liver not palpable .


Spleen not palpable 


Kidneys not palpable 


Lymph nodes not palpable 


PV examination -normal 


P/R examination -normal  



CNS EXAMINATION: 

Conscious 


Speech normal


No signs of meningeal irritation 


Cranial nerves: normal


Sensory system: normal


Motor system: normal


Reflexes: Right. Left. 


Biceps. ++. ++


Triceps. ++. ++


Supinator ++. ++


Knee. ++. ++


Ankle ++. ++




Gait: normal



Investigations 















Provisional diagnosis

Heart failure with CKD 

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