75 yrs old female patient came with complaints of chest pain associated with shortness of breath and pedal edema

 GENERAL MEDICINE CASE

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75 yrs old female patient came with complaints of chest pain associated with shortness of breath and pedal edema

Patient was apparently asymptomatic 4 days back and then developed chest pain which is diffuse,non radiating associated with shortness of breath( grade2-3) associated with wheeze and complaints ofpedal edema which is bilateral and pitting type.

No H/o Abdominal distension and no H/o decreased urine output.

Past history:- not a known case of diabetes milletus, hypertension, bronchial asthma, epilepsy.

O/E:

No pallor/Icterus/cyanosis/clubbing/Generalized lymphadenopathy/pedal edema 

Jvp raised.

Temp-afebrile

PR- 100bpm

RR-24/min

BP-120/90 mmhg

Spo2- 98%at RA

CVS- S1 S2 +,No murmurs

RS- bae+,B/L coarse crepts present.

P/A- soft, non tender 

CNS- No FND.

Investigations:-

USG:-

X ray:-

2d echo

https://youtu.be/fDWJu3Didfw

Provisional diagnosis:-

Heart failure with  secondary to CAD with moderate to severe LV dysfunction with community acquired pneumonia with GB polyps and infected hepatic cyst.

Treatment:-

Inj lasix 40 mg /IV/TID

Inj Augmentin 1.2g/IV/BD

Tab Azithromycin 500mg PO/OD.

Inj Hydrocort 100mg/IV/BD.

Nebulisation with Duolin, budecort with respules 6th hourly.

Inj optineuron 1 amp in 100ml NS/ IV/OD.

Inj pan 40 mg IV/BD