Diagnostic uncertainty of heart failure with preserved ejection fraction

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

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 

60 years old female Patient presented to casualty with symptoms of palpitations and increasing severity of shortness of breath Pedal edema ,dry cough . On examination:PRIMARY SURVEY  patient is tachypneic-RR-36/min Afebrile,profusely sweating Raised Jugular venous pressure Bilateral grade 2 pitting edema Pulse Rate - 150 beats / min,Irregular BP- 130/80 mmhg Spo2-94% at room air                                     Video showing raised jugular venous pressure Respiratory system - decreased breath sounds heard over left inframammary,infraxillary,infrascapular region Cardiovascular system - s1 and s2 heard immediately ECG was done that showed narrow complex tachycardia with irregular rhythm with absent P waves Suggestive of Atrial Fibrillation Patient was shifted to ICU And was given Inj. Amiodarone Stat And infusion continued for 24 hrs along with other supportive treatment . Patient heart rate decreased to 120/min and  continuous ECG monitoring was done . Aft