A 70/M potmaker by occupation with SOB since 3 months and B/L pedal edema since 2 months
70 year old male patient potmaker by occupation presented with C/O SOB since 3 months,B/L Lower limb swelling since 3 months
Patient was apparently asymptomatic 30 years ago then he developed sudden edema of right upper limb involving upto elbow non pitting type then he had H/O thorn prick over the right palmar region 15 days ago due to which his edema of the right limb increased and was associated with pain but relieved on medication. H/O scrotal swelling since 20 years initially right sided gradual in onset approximately a size of tennis ball ,got progressed to present size not associated with pain and appears to be B/L presently .3 months back patient developed SOB and got up from sleep in the night time. Since then he had SOB of grade III relieved on taking rest. Later he observed B/L pedal edema, pitting type intilally involving upto ankle joint later progressed upto thigh region since 2 months.
No H/O fever, chest pain, palpitations.
K/C/O HTN since 3 months and on medications.
No H/O DM,TB, Asthama,CVA, Epilepsy.
Mixed diet,normal appetite,bowel regular,C/O difficulty in micturition since 15 days.chronic alcoholic - toddy 1 bottle/day since 50 years and chronic smoker -4 chuttas/day since 50 years
Vitals :
Afebrile
PR : 108 bpm
BP : 140/70mmHg
RR : 20cpm
SPO2 : 99%
GRBS : 144mg/dl.
General examination:
Patient is C/C/C Moderately built and nourised.
Clubbing +,
Pedal edema +,pitting type.
No pallor, Icterus,Cyanosis, lymphadenopathy.
Systemic Examination:
CVS :- JVP Elevated, S1 S2 +, split S2 heard.
RS :- trachea central,BLAE+,NVBS+
P/A :-
Non tender,no palpable mass,hernial orifices intact.
CNS:- NAD
Provisional diagnosis : NYHA 3-4 HFmEF Secondary to ?CAD with chronic smoking and alcohol use disorder.
1st call discussion: Dr.Praveen
Approach to patient with Anasarca, how to localise organ systems and furthur evaluation
2nd call discussion: Dr. Rakesh Biswas
Difference between HFmEF & HFpEF
Clinical findings in patient with heart failure
Pg’s discussion
Triple therapy in heart failure
Titration of beta blocker therapy and ARBs
Intermittent dyspnea as a anginal equivalence
Interpretation of JVP and APEX BEAT
Etiology of HFrEF
Discussion as a part of Telemedicine
[12/01, 8:19 am] Dr Rakesh Biswas Sir Hod Gm Kam: Thanks for sharing.
What about mentioning the diagnosis for his 30 year old disease?
[12/01, 8:20 am] Filariasis sir may be?
Also share his chest X-ray and EcG
[12/01, 8:21 am] Dr Rakesh Biswas Sir Hod Gm Kam: Well captured systolic murmur. Wish we could hear it too using the audicor
[12/01, 8:26 am] Dr Rakesh Biswas Sir Hod Gm Kam: Other than bilateral pleural effusion to evaluate his heart we will need to see the Echo video
[14/01, 10:30 am] Dr Rakesh Biswas Sir Hod Gm Kam: HFmEF? 🤔
[14/01, 10:40 am] Dr Vanshi Gm Kam: Ef is 45 sir
[14/01, 10:41 am] Dr Rakesh Biswas Sir Hod Gm Kam: So what is HFmEF? Any links to this term?
[14/01, 10:42 am] Dr Adithya Sir Gm Kam: Heart Failure with Midrange Ejection Fraction. Considered HFrEF.
[14/01, 11:00 am] Dr Rakesh Biswas Sir Hod Gm Kam: Links or is this your original idea?
[14/01, 11:01 am] Dr Adithya Sir Gm Kam: Harrison's Principles of Internal Medicine 20th Edition Volume 2 Chapter 252. And I quote -
"Accordingly, the historical terms “systolic” and “diastolic” HF have been abandoned, and HF patients are now broadly categorized into HF with a reduced EF (HFrEF; formerly systolic failure) or HF with a pre-served EF (HRpEF; formerly diastolic failure). Patients with a LV EF between 40 and 50% have been considered as having a borderline or mid-range EF. At the time of this writing, the epidemiology of these patients is unclear."
[14/01, 11:07 am] Dr Rakesh Biswas Sir Hod Gm Kam: 👏any reference to anyone using its short form HFmEF?
[14/01, 11:10 am] Dr Adithya Sir Gm Kam: "Heart failure with mid-range ejection fraction A review of clinical status and meta-analysis of clinical management methods" https://www.oatext.com/heart-failure-with-mid-range-ejection-fraction-a-review-of-clinical-status-and-meta-analysis-of-clinical-management-methods.php#gsc.tab=0
[14/01, 11:18 am] Dr Rakesh Biswas Sir Hod Gm Kam: 👏 a good thesis always brings good learning points
Rx:
Day 1:
1)Inj.LASIX 40 mg IV BD
2)Tab.CARDIOVAS 3.125mg OD
3)Tab.RAMIPRIL 2.5 mg OD
4)Inj.THIAMINE 1Amp in 100 ml NS IV OD
5)BP/PR/SpO2 monitoring - hrly
6)GRBS monitoring - 6th hrly.
Day 2:
1)Inj.LASIX 40 mg IV BD
2)Inj.THIAMINE 1Amp in 100 ml NS IV OD
3)Tab.TELMESARTAN 40mg OD.
4)Tab.MET XL 25mg OD
5)Tab.SPIRANOLACTONE 25mg OD
6)BP/PR/SpO2 monitoring - hrly
7)GRBS monitoring - 6th hrly.
Day 3:
1)Inj.LASIX 40 mg IV BD
2)Inj.THIAMINE 1Amp in 100 ml NS IV OD
3)Tab.TELMESARTAN 40mg OD.
4)Tab.MET XL 25mg OD
5)Tab.SPIRANOLACTONE 25mg OD
6)BP/PR/SpO2 monitoring - hrly
7)GRBS monitoring - 6th hrly.
Day 4:
1)Inj.LASIX 80mg(8AM) & 40mg(8PM)
2)Tab.TELMESARTAN 40mg OD.
3)Tab.MET XL 25mg OD
4)Tab.SPIRANOLACTONE 25mg OD
5)Syp.CREMAFFIN PLUS 15ml H/S
6)BP/PR/SpO2 monitoring - hrly
7)GRBS monitoring - 6th hrly.
