Case of HFrEF
POSTOP MVR
50 yr old female ,resident of masanpally , farmer by occupation came to the casuality with c/o SOB( Grade II -III) since 3 days
B/L pedal edema since 8 months (on &off) subsiding with medication & worsening since 1 week
Patient was her usual self 15 yrs back ; then she had c/o SOB and was taken to hospital where angiogram (coronary) was done and 7 yrs back Mitral valve replacement was done (she was on regular medications since then )
H/o B/L pedal edema ,pitting type and H/o vomitings (2/3 episodes per day ) on &off since 8 months
K/c/o DM since 4 yrs (discontinued medication for last 3 months)
On admission 18/7/21 RBS - 150mg/dl
On 19/7/21 FBS - 147 mg/dl
PLBS - 220 mg/dl
On 20/7/2021 HbA1c -7.3 %
PLBS -244mg/dl
H/o similar complaints in the past
Blood transfusion done at the time of surgery (MVR)
No addictions
Diet - Mixed
Appetite - Normal
Sleep -adequate
Bowel and bladder movements - Regular
No h/o burning micturition
General Examination
Patient is conscious ,coherent and cooperative
Moderately built and nourished
No pallor , icterus , cyanosis and lymphadenopathy
Edema - present (pitting type)
Vitals
Afebrile
BP - 130/80 mmHg
PR 109 bpm
RR 36cpm
RBS - 150mg/dl
Systemic Examination
S1,S2 heard
B/L air entry present
Apex beat at 6th ICS lateral to Mid clavicular line
Parasternal haeve present
Palpable p2
JVP raised
Dyspnea (grade 2 - grade 3)
Investigations done
ECG , Hemogram , PT , APTT ,CUE ,RBS , LFT ,RFT, Chest Xray
ECG on 18/7/21
Chest Xray
ECG on 19/7/21
2d ECHO
Provisional diagnosis
HFrEF (EF -25%)
Severe LVD/CAD / Post op MVR(Sx 4yrs back) ?RHD
Treatment
Fluid restriction < 1 lt /day
Salt restriction < 2gm/day
Inj. LASIX 40mg BD
Tab. MET-XL 12.5mg BD
Tab. ACITROM 1mg OD /PO
Tab. ECOSPRIN 75 mg OD /PO
Tab.RAMIPRIL 2.5 mg OD/PO
Tab.ATORVASTATIN 40mg OD/PO
Tab.GLIMIPERIDE 1mg
Tab.DIGOXIN 0.25 mg (5days/week)
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