58 year old male, labourer by occupation, came to the OPD with the chief complaints of Shortness of breath since 15 days, worsened 3 days back, facial puffiness since 1 week
History of presenting Illness -
Patient was apparently asymptomatic 4 years ago
4 years ago - pt complained of giddiness, went to a local hospital and was diagnosed as Hypertensive, on regular medication since then T. Nicardia 10mg, T. Arkamine 0.1mg sos
2 years back Pt developed B/L pedal edema, progressed gradually to knees, diagnosed with renal failure and initiated dialysis weekly twice
Left upper limb swelling, gradually progressing to current size, since 4 months . Swelling in the left chest region, gradually progressing to current size, since 5 months
Back pain since 3 months, subsided on medication (T. Ultracet)
Shortness of breath since 45 days
Grade II-III progressed to Grade IV since 45 days along with orthopnea
27 days back - developed Facial puffiness
No c/o palpitations, giddiness, cold, cough, burning micturition
Past history -
Known case of Hypertension since 4years on Tab nifedipine 10mg OD
Not K/C/O TB, Epilepsy, Asthma, CAD.
Personal history
Appetite- normal
Diet- mixed
Bowel movement- Regular
Alcoholic stopped 4 yrs ago
Non smoker
On examination
Pt is C/c/c
No Pallor,Icterus,Cyanosis,Lymphadenopathy
Edema of feet +
Vitals
Pr:94bpm
Bp:120/80
Spo2:97% at RA
Temp - Afebrile
Today's Vitals
Bp 130/90
PR 95
Spo2 99
Temp - afebrile
Systemic examination
CVS - S1,S2 +
RS - BAE +
CNS - NAD
P/A- Soft, non tender
Investigations
Serology - Negative
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