Tuesday, 20 July 2021

Med. case 1

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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