A 52 year male with pedal edema, SOB, abdominal distension, facial puffiness.
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CASE PRESENTATION:
A 52year male, carpenter by occupation, resident of bhongir, had H/O excessive daytime sleepiness 10yrs back, for which he went to hospital and was diagnosed with diabetes and on oral hypoglycemic drugs and on regular follow-up.
After 4-5 yrs, one fine night, pt was found unresponsive and was profusely sweating,? Hypoglycemic epidode,later he was shifted to hospital and was diagnosed with some cardiac condition for which angiogram was done, reports are absent. 2D echo at that time showed? Cardiomegaly.
No H/O pedal edema, SOB
He was diagnosed with HTN and? Heart failure and was put on antihypertensives, antiplatelets(pt used antiplatelets for 2yrs and stoped)
15to 20 days back, pt had abdominal distension, for which he went to hospital and diagnosed with cholelithiasis and used herbal medications for 1 week and after stopping them, pt now presented to opd with c/o B/l pedal edema since 10days,abdominal distension present, facial puffiness present, SOB since 10days,gradually progressive. He wakes up after sleeping for 2to 3hrs with SOB, sits up for 5to30mins and later goes to sleep. 2days back, pt had 1 episode of profuse sweating, associated with drowsiness, cold peripheries . pt was immediately taken to area hospital and his GRBS was 51mg/dl. He was admitted in OU hospital for 1day and was discharged with medications. Yesterday pt felt sudden onset of SOB at 1:30 AM amd couldn't sleep. Pt alsohad profuse sweating and cold peripheries(hypoglycemic episode withGRBS:51mg/dl)
Tingling and numbness in b/l lower limbs, constipation present. Pt complained of decreased urine output since 3 days
No H/O chest pain, palpitations, burning micturition, fever, cough, cold
K/c/o DM and Hypertension
No H/O TB, epilepsy, asthma,thyroid abnormalities
Personal history :
Diet-mixed
Appetite-normal
Sleep-adequate
B/B-burning micturation and constiption present
No addictions
General examination:
Pt is consious, coherent, cooperative
No palor, icterus, clubbing, cyanosis, lymphadenopathy
B/l pedal edema present
Vitals:
Temp:98.4F
PR:76/min, regular
BP:120/80mm Hg
RR:24cpm
Cvs:s1 s2+
Rs:BAE+, decreased AE on right IAA area, ISA area
Cns:NAD
P/A:distended
Investigations:
USG abdomen:
USG chest:
Venous doppler:
2D echo:
RA:dilated
RV:dilated
LA:dilated
LV:dilated, global akinetic
EF:36%
impression:all chambers dilated
Diagnosis:
Dilated cardiomyopathy with right pleural effusion, secondary to ?CAD
Cardio renal syndrome type 2
Diabetes melitus, hypertension, alcoholic
Diabetic neuropathy
Drug induced hypoglycemia-resolved
Treatment:
Fluid restriction(<1.5lit/day)
Salt restriction(<2.5gms/day)
Inj lasix40mg iv tid if sbp>110mm hg
Tab cardivas 3.125mg po od
Tab ecosprin 75mg po od
Tab pan 40mg po od
Inj neomol 100ml iv sos if temp>101°F
Tab pcm 650mg po tid
Syp lactulose 10ml po tid
Tab digoxin 0.25mg po od
Inj HAI sc according to sliding scale
