Heart failure with preserved ejection fraction ?

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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 diastole and systole ,showing normal  Visual Ejection fraction . 




2D echo showing :
Concentric left ventricular hypertrophy
With normal chambers,no regurgitations
Ejection fraction -60%


Chest x ray -showing haziness over both lung fields 



Complete blood and urine examination are within normal limits
Serum albumin normal 

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