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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