50F presented with SOB and pedal edema.

50F presented to opd with complaining sob since 1day and pedal edema since 2days.


Pt apparently asymptomatic 4yrs back then she developed pedal edema gradual onset intermittent type (on&off) aggrevated on rest, relieved on work, progressed to upper limbs and face subsided without medication.
SOB since yesterday sudden onset and progressive in nature.a/w palpitations. No chest pain, headache.
No h/o orthopnea,PND.
PAST HISTORY: 
K/c/o HTN since 2yrs & on metoprolol 50 mg
No h/o dm, Asthma, seizures,ckd, TB 
H/0 hemirrhoidectomy 4yrs back 
H/0 arthritis since 2yrs for which intra articular injection given.
PERSONAL HISTORY: farmer by occupation.appetite normal, bowel & bladder movements regular.

GENERAL PHYSICAL EXAMINATION: 
Moderately built and nourished.

Pallor + ;no icterus ,cyanosis ,clubbing ,koilonychia, generalized lymphadenopathy.
 Pedal edema B/L pitting type

Resolved  by 17/09/20
Jvp raised 

Vitals 
Temperature afebrile
bp 140/80 rt arm supine position
 pr : rate 90/min ,rhythm volume,character.
RR 22cpm 
SpO2 at room air 98% 
Grbs 189mg/dl
SYSTEMIC EXAMINATION:
CVS :
INSPECTION : no precordial bulge
PALPATION :apex beat at 6th ICS anterior axillary line. no para sternal heave.
AUSCULTATION : S1S2 heard, no murmurs
RS : B/L air entry present .
No added sounds 
PER ABDOMEN: no oraganomegaly
CNS: NFND 
INVESTIGATIONS: 
HEAMOGRAM
 serum electrolytes on 16/09/20

LFT 



CXR 
ECG
2D Echo on 15/09/2020

2D ECHO again on 16/09/2020 for ivc diameter 
https://photos.app.goo.gl/7wTjV5NT1Y6LnxGQ6
IVC diameter is 1.6cm
USG ABDOMEN


DIAGNOSIS : Heart failure  with preserved ejection fraction with mild PAH type 2 With hypertension.
TREATMENT: 
Propped up position
Fluid restriction ie <1lit/day
Salt restriction 
Inj LASIX 40mg /iv/tid
Foley's catheterization
Daily wt monitoring
Bp/pr/spo2 hrly
Oxygenation to maintain spo2>90%.



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