HEART FAILURE WITH PRESERVED EJECTION FRACTION WITH CAD

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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 
K/c/o HTN since 5 years on Telmisartan 80 mg /once daily 
K/c/o CAD- on clopidogrel 75 mg /once daily 
History of 2 PRBC transfusions done 

On examination : 
Pallor ++ 
Dyspnea +
Pedal edema - grade 2 ,bilateral , pitting 
Raised Jugular venous pressure 
Pulse rate - normal volume ,regular in rhythm ,94 beats / min 
BP- 150/100 mmhg 
Spo2-99 % room air 
Respiratory system : normal vesicular breath sounds heard 
Cardiovascular system -s1 and s2 heard with Hemic Murmur at pulmonary area 
Per Abdomen -soft 
CNS- normal 

Provisional diagnosis:
 Shortness of breath secondary to ? Heart failure 
Anemia 
K/c/o DM,HTN,CAD 

Investigations : 
Complete blood picture showed microcytic  hypochromic anemia 
Cue - normal 
Ecg -showed old anterior wall MI changes 
Iron studies showed - iron deficiency anemia 

2D ECHO showed :
Concentric Left Ventricular hypertrophy 
With ejection fraction near -58% 


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