A 75 year old female patient with shortness of breath ,Bilateral pedal edema
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Chief complaints:
75 year old female patient was brought to casualty with chief complaints of: C/o shortness of breath since 10 days Bilateral pedal edema since 10 days Facial puffiness since 10 days H/o of palpitation 10 days
HOPI:
Patient was apparently asymptomatic 15 days back & then she developed fever - low grade, intermittent, decreased with Rx
Shortness of breath since 10days which was insidious in onset, gradually progressed from class 2-4, Orthopnea present
C/o palpitations since 10 days B/I pedal edema since 10 days which was
pitting type extending upto knee Facial puffiness present.
No history of chest pain, syncope attack. No history of decreased urine output, abdominal distention. No other complaints
Personal history:
Diet:mixed
Appetite:normal
Bowel and bladder movements:normal
Appetite : decreased
Sleep : adequate
No additions
On examination:
Pt is c/c/c to time place and person
pallor: present
B/l pedal edema-pitting type extending upto knees
No cyanosis, clubbing or generalised lymphadenopathy
TEMP:99f
PR:130
BP:150/90 mmhg
RR: 32cpm
SPO2: 88-92% on RA
CVS: JVP is raised apex beat- diffused parasternal heave +Palpable P2+
S1 S2+
RS: barrel shaped chest, trachea central BAE+, B/l Crepts+
P/A: soft nontender
CNS: NFND
Inspection-
Shape of abdomen normal
Umbilicus -central and inverted
No visible scars,sinuses,dilated veins
Hernial orifices normal
Palpation -no local rise of temperature
No Tenderness present
No guarding,rigidity,rebound tenderness
No hepatomegaly,spleenomegaly
Percussion-
Resonant
Ascultation-
Bowel sounds+
Investigation:
Serology: Negative
Hemogram:
ECG:
ECG at time of presentation
X-Ray:
D/D:
Atrial fibrillation or cardiac failure?
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