HFPEF with Daibetic triopathy,HTN.

-

IP no- 202003539
Here we discuss an interesting patient with signs and symptoms suggestive of heart failure but has normal systolic function .

To start with ,
A 53year old male patient  who is driver by occupation came with complaints of

  • Left foot ulcer since 1 year that is non healing , painless.
  • Left lower limb swelling since 6 months that progresses to right lower limb since 2 months
  • Shortness of breath since 6 months-Initially patient was able to climb stairs at home without shortness of breath,since 6 months patient noticed shortness of breath on climbing stairs that worsened over 2 months ,now patient is unable to climb stairs and takes pause in between ,he also complaints of orthopnea ,paroxysmal nocturnal dyspnoea,and dry cough whenever he sleeps on supine position. .patient also complaints that he is being unable sleep on flat surfaces and is being using 3 pillows , there is no history of chest pain ,palpitations,wheeze and seasonal variation of SOB


  • Abdominal distension since 2months , with no pain abdomen ,vomitings,bowel habits are regular .
  • Decreased urine output since 2 months ,no burning micturition,facial puffiness
  • Diminision of vision in right eye since 2 months .


Risk factors:
K/c/o Diabetic since 9 years previously on insulin and OHA
K/c/o HTN since 9 years on ATENOLOL 25 mg then changed to clinidipine 10 mg
He chew Tobaccco (Gutka) for 11 years ,stopped since 6 months
Chronic alcoholic (whisky(90-180 ml-3-4 times / week ) stopped since 2 years
History of surgery for ischiorectal abscess 10 years back.

On examination:
Patient is conscious ,coherent ,coperative
Pedal edema-grade4 with left foot tropic ulcer
PR-70/min ,regular rhythm,normal volume
BP-170/100 mmhg
Dyspneic
Spo2-94% at room air
CVS- s1 and s2 heard with pansystolic murmur in Mitral and Tricuspid area
RS- Fine crepetations heard over bilateral infrascapular and infraxillary area with absent breath sounds .
P/A- soft ,non tender
Fundoscopy— left eye severe NPDR with Hypertensive retinopathy grade 3 ,right fundus couldn’t be seen due to cataract.

Provisional Diagnosis : 
Heart failure with bilateral pleural effusion
Diabetes
Hypertension

Investigations: 



   













28/1/2020

Recent chest x ray

2D echo was done and it showed: 


 


With signs and symptoms of heart failure ,patient was started on preload and after load reducing agents .

Discussion : 
1. Why patient had heart failure even when his systolic function is normal 
2. Did Dilated cardiomyopathy cause heart failure or heart failure caused Dilated Chambers 
3 .Diagnostic and therapeutic approach to  a patient with signs and symptoms of heart failure but 2d echo showing normal ejection fraction. 
4. Diabetes and heart failure .
5. Alcoholic cardiomyopathy 
6.Pathophysiology of pleural effusion in heart failure .


Comments

Post a Comment

Popular posts from this blog

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

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 ?

-
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