80yr old female came to opd with cheif complaints of sob, pedal edema since 8days.

80year old female came to opd with cheif complaints SOB, pedal edema and generalized weakness

March 29, 2022

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80 year old female housewife by occupation presented with cheif complaints of difficulty in breathing since 8 days, swelling in legs since 8 days.

HOPI:-
Patient was apparently asymptomatic 28 days back then she suffered trauma due to slipping in the bathroom, she fell in sitting position and complained of left hip pain. 

She could walk normally for 4 days but later complained of too much pain and was confined to bed and had generalized weakness.

She developed of Shortness Of Breath which was insidious in onset.Initially it was garde-2 but from 21/3/22 she had Shortness of breath at rest (grade-4) and was taken to a local hospital where she was told that her right heart is not functioning properly and put on O2. She improved and was advised to come here it is associated with abdominal pain giddiness and pedal edema.
No h/o fever,headache and vomitings.

H/o COVID 19 infection in April 2021, her symptoms were cold, Shortness of breath and generalized weakness, for which she isolated at home and used medication for 1 week. All her symptoms improved but the weakness took 3 months to subside. 

PAST HISTORY:-
She was diagnosed with Hypertension 20 years back when she had an episode of giddiness associated with loss of consciousness, she received treatment for 3-4 days at the hospital. 

She was also diagnosed with Diabetes Mellitus 13years back when she went for a regular check up.
And using medication for DM and HTN.
 No h/o asthma,TB, epilepsy.

Surgical history: 
Underwent appendectomy 45 years back and hysterectomy 25 years back. 

Family history:-
Her son has DM and her daughter has HTN.

Personal history: 
Weight loss has noticed
Diet: mixed 
Appetite: reduced
Sleep: disturbed, unable to sleep at night
Bowel and bladder movement: regular 
Addictions: none 

General examination: 
Patient is conscious, coherent and cooperative. 
She is oriented to place and person but not to time. 
Pallor present. 
B/L PITTING TYPE PEDAL EDEMA
No icterus, cyanosis, clubbing, lymphadenopathy. 
 
CLINICAL IMAGES-

Vitals on admission: 
Temp: 98.6
PR: 90/min
BP: 120/70 mmHg
RR: 18/min
CVS: S1 S2 present 
JVP raised 
RS: BAE +
Decreased breath sounds on left side. 
Crepitations heard in left infrascapular area,inframammary area and interscapular area. 

CNS: E4V5M6

P/A: soft, non tender 

Investigations: 
BGT: O positive 

HEMOGRAM: 
Hb: 8.3
TLC: 13,300
N/L/E/M: 79/11/4/6
Plt: 4.37 lakh
PCV: 24.9
MCH: 26.0

Serum Iron: 58
Retic count: 1.8%
Troponin I: negative 

Serology: negative 
RBS:189mg/dl
HbA1c: 6.9%
ESR: 25
CRP: Positive (2.4mg/dl)

LFT: 
Tb: 0.69
DB: 0.20
AST: 798
ALT: 644
TP: 5.8
Alb: 2.88
A/G: 0.99

RFT: 
B urea: 54
S Creat: 1.9
Uric acid: 10.5
Na: 135
K: 4.3
Cl: 98


Chest X-ray:-
X Ray pelvis AP:-



X ray left thigh lateral: 



ECG 



USG abdomen




Diagnosis:

RIGHT VENTRICULAR FAILURE WITH PULMONARY ARTERY HYPERTENSION WITH ACUTE HEPATITIS 
WITH K/C/O DM & HTN 

Treatment: 
1. Tab. ECOSPORIN/AV 75/20 mg OD
2 .Inj. MONOCEF 1gm IV BD
3. Inj. LASIX 20mg IV BD
4. GRBS 6th hourly

NEW ADMISSION
ICU FIRST BED
23/3/22

S: 
B/L pedal edema 
Generalized weakness 

O: 

Temp: 98.3
PR: 89
RR: 22
BP: 
CVS: S1 S2 present 
JVP raised 
RS: BAE +
Decreased breath sounds on left side. 
Crepitations heard in left infrascapular area,inframmary area and interscapular area. 

CNS: E4V5M6

HEMOGRAM: 
Hb: 8.3
TLC: 13,300
N/L/E/M: 79/11/4/6
Plt: 4.37 lakh
PCV: 24.9
MCH: 26.0

Serum Iron: 58
Retic count: 1.8%
Troponin I: negative 

Serology: negative 
RBS:189mg/dl
HbA1c: 6.9%
ESR: 25
CRP: Positive (2.4mg/dl)

LFT: 
Tb: 0.69
DB: 0.20
AST: 798
ALT: 644
TP: 5.8
Alb: 2.88
A/G: 0.99

RFT: 
B urea: 54
S Creat: 1.9
Uric acid: 10.5
Na: 135
K: 4.3
Cl: 98

A: 
RIGHT VENTRICULAR FAILURE with PULMONARY ARTERIAL HYPERTENSION WITH ACUTE HEPATITIS 
WITH DM & HTN 

P:

1.Tab. ECOSPORIN/AV 75/20 mg OD
2. Inj. MONOCEF 1gm IV BD
3. Inj. LASIX 20mg IV BD 
4. GRBS 6th hourly

AMC 3rd bed 
24/3/22

S: 
B/L pedal edema 
Generalized weakness 

O: 

Temp: 98.5°F
PR: 92bpm
RR: 20 cpm
BP: 140/70 mmHg
CVS: S1 S2 present 
JVP raised 
RS: BAE +
Decreased breath sounds on left side. 
Crepitations heard in left infrascapular area,inframmary area and interscapular area. 

CNS: E4V5M6

HEMOGRAM: 24/3/22
Hb: 8
TLC: 9,80
N/L/E/M: 70/16/4/10
Plt: 3.22 lakh
PCV: 24
MCH: 26.1

A: 
RIGHT VENTRICULAR FAILURE with PULMONARY ARTERIAL HYPERTENSION WITH ACUTE HEPATITIS 
WITH DM & HTN 

P:

1.Tab. ECOSPORIN/AV 75/20 mg OD
2. Inj. MONOCEF 1gm IV BD (D2)
3. Inj. LASIX 20mg IV BD 
4. GRBS 6th hourly

Pedal edema on 24/3/22 




Ophthalmology referral done I/V/O Cataract



Orthopaedic referral I/V/O Left hip pain


Ward case 
25/3/22

S: 
Left hip pain (decreasing) 
B/L pedal edema 
Generalized weakness 

O: 

Temp: 98.5°F
PR: 107bpm
RR: 16 cpm
BP: 120/70 mmHg
CVS: S1 S2 present 
RS: BAE +
Decreased breath sounds on left side. 
Crepitations heard in left infrascapular area,inframmary area and interscapular area. 

CNS: E4V5M6

24/3/22
Sr creatinine 1.0
Sr urea 34

LFT
TB: 0.68
DB: 0.18
AST: 156
ALT: 328
ALP: 168
TP: 5.5
Alb: 2.5
A/G: 0.84


25/3/22

Sr. Creatinine 1.1
Blood urea 27

LFT 
TB: 0.61
Db: 0.16
AST: 79
ALT: 221
Alk P: 194
TP: 5.1
Albumin: 2.6
A/G: 1.08 


A: 
RIGHT VENTRICULAR FAILURE with PULMONARY ARTERIAL HYPERTENSION WITH ACUTE HEPATITIS 
WITH DM since 13 years & HTN since 20 years 

P:

1.Tab. ECOSPORIN/AV 75/20 mg OD
2. Inj. MONOCEF 1gm IV BD
3. Inj. LASIX 20mg IV BD 
4. GRBS 6th hourly
5. Tab. METFORMIN PO OD (8PM)
6. Tab. CILNIDIPINE 10mg PO OD
7. Tab. GLIMI M1 PO/OD
8. INJ. ZOFER 4mg IV TID 
9. I/O charting
10. Vitals monitoring 4th hourly

Ward case 
27/3/22
S: 
B/L pedal edema decreased 
Left hip pain decreased 

O: 

Temp: 98.5°F
PR: 92bpm
RR: 19 cpm
BP: 130/70 mmHg
CVS: S1 S2 present 
RS: BAE +
Decreased breath sounds on left side. 
Crepitations heard in left infrascapular area,inframmary area and interscapular area. 

CNS: E4V5M6

A: 
RIGHT VENTRICULAR FAILURE with PULMONARY ARTERIAL HYPERTENSION WITH ACUTE HEPATITIS 
WITH DM since 3 years & HTN since 20 years  

P:

1.Tab. ECOSPORIN/AV 75/20 mg OD
2. Inj. MONOCEF 1gm IV BD
3. Inj. LASIX 20mg IV BD (8 AM and 8 PM)
4. GRBS 6th hourly
5. Tab. METFORMIN 500mg PO BD 
6. Inj. ZOFER 4mg IV TID 
7. Tab. RAMIPRIL 2.5mg PO OD 
8. Tab. GLIMI M1 PO OD 
9. Vitals monitoring 4th hourly

Ward case 
28/3/22
S: 
B/L pedal edema decreased 
Left hip pain decreased 

O: 

Temp: 98.5°F
PR: 96bpm
RR: 20 cpm
BP: 110/70 mmHg
CVS: S1 S2 present 
RS: BAE +
Decreased breath sounds on left side. 
Crepitations heard in left infrascapular area,inframmary area and interscapular area. 

CNS: E4V5M6

A: 
RIGHT VENTRICULAR FAILURE with PULMONARY ARTERIAL HYPERTENSION WITH ACUTE HEPATITIS 
WITH DM since 3 years & HTN since 20 years  

P:

1.Tab. ECOSPORIN/AV 75/20 mg OD
2. Inj. MONOCEF 1gm IV BD
3. Inj. LASIX 20mg IV BD (8 AM and 8 PM)
4. GRBS 6th hourly
5. Tab. METFORMIN 500mg PO BD 
6. Inj. ZOFER 4mg IV TID 
7. Tab. RAMIPRIL 2.5mg PO OD 
8. Tab. GLIMI M1 PO OD 
9. Vitals monitoring 4th hourly

Reference log:-
https://caseopinionsbyrollno156.blogspot.com/2022/03/80year-old-with-sob-pedal-edema-and.html

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