49M CCF pulmonary edema, anemia 2 weeks, Diabetes 8 years

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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

C/o. Shotrness of breath 1 week

Cough 1week

Bl .pedal edema 1 week.

History of presenting illness

10 yrs ago pt went to hospital for right upper quadrant pain then doctor told then that he has some liver problem( admitted for 1 week, no previous reports?

8 yrs back pt went to hospital with c/o lossing weight. He was diagnosed diabetic

And pt is on irregular medication(metformin 500 mg po od) from then on.

10 days back he was having sob grade II, swelling in both limbs. Went to miryalaguda hospital from there he was refered to our hospital

On 28 dec pt came to our hospital with the below complaints

Shortnsess of breath which is gradually in onset associated with sever body pains and weekness ,sob increases with exercise and orthopnoea present

No h/0 fever vomiting diarrhoea

cough present associated with sputum white in color, gradual in onset

Pedal oedema is pitting type and gradual in onset

Past history

Diabetes since 8 yr TAB METFORMIN500 mg

N/k/c/0 HTN ,ASTHMA , TB

K/c/o EPILEPSY last episode 40 yrs ago

Personal history

Occupation: He works in gold shop as a shop keeper

He drinks 1 quarter alcohol almost everyday since 15 yrs and every night when he drinks he doesn't eat any food

General examination

Pt is c/cc

Pallor present

B/l pedal edema present

Vitals

Bp 110/70 mmhg

Pr 82bpm

Rr 20 cpm

Cvs

Auscultation s1 s2 heard

Mid diastolic murmur present

Resp system

Bilateral air entry present

P/a soft nontender

Investigation on 28/12/23

Investigation 29/12/23

Investigation 30/12/23

Hb% and total count graph

Xray chest

Fever charT

Usg abd and pelvis

2d echo

On 1.1.24 video link

https://youtu.be/BMTzR86_h90?si=KmophcBuqDOEHp2f

2d echo 3/1/24 video link

https://youtu.be/r5-nXzEhGGk?si=5uNdXcAD_RttYTlb

2d echo of non colapsing ivc

https://youtube.com/shorts/zdi5uHD8tf4?si=ol5ABTFWlN5s6Hd9

Ecg

HRCT

https://youtube.com/shorts/l17b4zA4QHE?si=OZVlEsepKFR2_XIc

https://youtube.com/shorts/t0wOsQPIkXM?si=mykNPPF3oPSupIV0

COURSE IN HOSPITAL-

49 YR OLD MALE PRESENTED TO OPD WITH ABOVE MENTION COMPLAINS-COUGH WITH SPUTUM, PEDAL OEDEMA AND SHORTNESS OF BREATH AND THOROUGH CLINICAL AND METABOLIC EVALUATION WAS DONE. PT WAS DIAGNOSED WITH HEART FAILURE WITH MIDRANGE EF =47%, WITH COMMUNITY ACQUIRED PNEUMONIA AND ANEMIA SECONDARY TO IRON DEFICIENCY. AFTER SENDING BLOOD AND URINE CULTURES, IV MEDICATIONS AND ANTIBIOTICS WERE STARTED, INTERMITTENT CPAP SUPPORT WAS GIVEN

ON DAY 3 OF ADMISSION, AS HEMOGLOBIN WAS -7.4 GM/DL PRBC TRANSFUSION DONE AND AS ALBUMIN WAS 2.2-INJ.20% ALBUMIN WAS TRANSFUSED.

2DECHO- EJECTION FRACTION-47% ALL CHAMBERS DILATED SEVERE TR+ WITH PAH MODERATE AR+, MODERATE MR+RWMA LAD HYPOKINETIC, NO AS/MS-MILD TO MODERATE LV DYSFUNCTION. NO DIASTOLIC DYSFUNCTION NO LV CLOT,-IVC SIZE 2.22 CMS DILATED NON COLAPSING.PT WAS TREATED FOR HEART FAILURE AND MIDRANGED EF 47%.

ON DAY 6, AS PATIENT CONTINUED TO HAVE SHORTNESS OF BREATH AND PEDAL OEDEMA, PULMONOLGY OPINION WAS TAKEN.HRCT-CHEST WAS DONE, WHICH SHOWED MULTIPLE CONSOLIDATIONS ON BOTH LUNGS WITHNO ZONAL OR LOBAR PREDILECTION F/S/O BRONCHOPNEUMONIA, PROMINENCE OF CARDIAC CHANBERS. BIL MILD TO MODERATE PLEURAL EFFUSION. CHRONIC CALCIFIC PANCREATITIS. IV ANTIBIOTICS WERE ESCALATED

REVIEW 2DECHO- RWMA LAD AKINETIC RCA AND LCX HYPOKINETIC. SEVERE TR WITH PAH MODERATE AR/MR.SCLEROTIC AV, NO AS/MS EF 35% RVSP 75+20-95 MMHG.SEVERE LV DYSFUNCTION.NO DIASTOLIC DYSFUNCTION.MINIMAL PE AND PLEURAL EFFUSION IVC SIZE 1.70 CMS DILATED COLLAPSING, ALL CHAMBERS DILATED

PT WAS TREATED FOR HEART FAILURE WITH REDUCED EF 35% WITH SEVERE PULMONARY HYPERTENSION. CONTINUOUS CPAP SUPPORT WAS GIVEN. INJ.LASIX INFUSION 100MG@5ML/HR WAS GIVEN 3DAYS. CARDIOLOGY OPINION WAS TAKEN AND ADVISED TO CONTINUE THE SAME MEDICATION PATIENT SYMPTOMATICALLY IMPROVED, PEDAL EDEMA REDUCED, SHORTNESS OF BREATH AND COUGH SUBSIDED PATIENT IS BEING DISCHARGED IN HEMODYNAMICALLY STABLE CONDTION.

Electronic discharge