Suspected heart failure with preserved ejection fraction

-
Ip no - 201900829917
39 yr old female patient sand weaver by occupation came with complaints of shortness of breath and pedal edema since 4days that are gradually progressive ( grade2-3),she siad she used to stop in between when she was to walk for long distance that gradually progressed to shortness of breath for small distance over period of 4 days and  there also history of  orthopneoa and 2 episodes of PND associated with dry cough that resolved.
No h/o wheeze,cold,fever,burning micturition, decreased urine output

Past history : 
20 yrs back when she was 5 months of gestation she developed pedal edema,facial puffiness and gestational hypertension and she was treated for it.after 5-6 months of delivery her pedal edema decreased.

Then 14 yrs back during 2nd child birth she developed shortness of breath and emergency LSCS was done

K/c/o peripartum cardiomyopathy? 

She also gives history of using antihypertensive  medications intermittently prescribed  by RMP 

Non diabetic,non asthmatic,no h/o epilepsy

O/e - 
Afebrile ,no pallor 
Bilateral pitting type of pedal edema-grade2
Raised JVP + 
No lymphadenopathy,no cyanosis,no koilonychia
Bp-150/100
RR-26/min
CVS- s1,S2 heard 
RS- Normal vesicular breath sounds heard 
P/A- soft 
Cns - normal 

Provisional daignosis- 
Heart failure with preserved ejection fraction 
K/c/o peripartum cardiomyopathy 
Idiopathic edema of women 
Hypothyroidism 


We evaluated her further 
Baseline investigations were sent .
Routine blood and urine investigations came to be normal
TSH -3.85 
Serum albumin -3.1 

Ecg ,2d echo was done and showed normal findings 









Chest x-ray and PFT were also done that showed normal findings 

In view of clinical features and signs of heart failure ;our most probable diagnosis was heart failure with preserved ejection fraction on background of  Hypertension and She was treated with preload reducing drug-lasix,and her shortness of breath and pedal edema subsided gradually.




Comments

Post a Comment

Popular posts from this blog

SUSPECTED HEART FAILURE WITH PRESERVED EJECTION FRACTION

-
Image
Ip no- 65 year old male patient presented to OPD with complaints of 1. Pedal edema since 10 days 2.shortness of breath since 10 days 3.fever and cough since 10 days Patient was apparently asymptomatic 10 days back then he developed pedal edema that started from lower limb and extended to trunk and then to face . No h/o decreased urine output Shortness of breath since 10 days ,patient is unable to walk  for long distance and stops in between ,history of wheeze present ,no seasonal variation , chest pain ,no orthopnea ,no PND ,no h/o chest pain History of Intermittent low grade fever Since 10 days associated with productive cough- non foul smelling,mucoid in consistency No h/o loose stools,vomitings,pain abdomen ,burning micturition No h/o DM,HTN,ASTHMA,EPILEPSY,CAD  Risk Factors: Chronic alcoholic - used to drink 160 ml/day for 40 years ,stopped 1 month back Chronic smoker- used to smoke 1 pack of beedi/day for 40 years and stopped 1 month back On examination : Patien
Read more

HEART FAILURE WITH PRESERVED EJECTION FRACTION WITH CAD

-
Ip no- 201926931 DOA-17/7/2019 DOD- 23/07/2019 60 year old female patient came with complaints of 1.shortness of breath since 5 years aggravated since 2 months  2.pedal edema since 5 years  3.constipation since 1 and half month  Patient was apparently assymptomatic 5 years back then she developed left sided chest pain associated with shortness of breath ,was diagnosed with CORONARY ARTERY DISEASE-double vessel wall disease and PTCA was done in 2015 to RCA ,since then patient complaints of intermittent shortness of breath that aggravated since 2 months .patient finds difficulty in talking and walking for short distance even to bathroom and has to stop in between due to breathlessness , Patient complaints of shortness of breath after taking food .  Bilateral pedal edema extending till knee . No h/o  Constipation since 1 and half month ,no pain abdomen ,passing stools every 3 days  Risk factors :  Patient is k/c/o T2 DM since 5 years on glycomet M2 once daily 
Read more

Heart failure with preserved ejection fraction ?

-
Image
IP no - 201937173 40/M came to casualty with  Sudden onset of shortness of breath that progressed from grade 2 to grade 4 ,associated with pedal edema ,orthopnea,PND History of fever 1 week back associated with loose stools for 3 days  Burning micturition and facial puffiness since 5-6 days ,edema gradually progressed to trunk ,lower limb  And decreased urine output  Hematuria since 4days  Occasional alcoholic Non smoker  Non diabetic ,non hypertensive,no history of asthma,coronary artery disease    10 yrs back operated for left renal calculi  O/e  B/l pitting edema +  PR-76/min regular  Bp- 200/120 mmhg  hlf hr later 190/90 mmhg RS- wheeze + occasionally  Decreased air entry over right infrascapular and infraxillary areas  B/l crepts +  Spo2 -97 at room air  CVS -s1 S2 heard  Cns - NAD Provisional Diagnosis : Acute pulmonary edema (?HFPEF) UTI Denovo Hypertensive     ECG showed normal rhythm  2D echo picture short axis view in phase of diastol
Read more