Diagnostic uncertainty of heart failure with preserved ejection fraction

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SUSPECTED HEART FAILURE WITH PRESERVED EJECTION FRACTION

- June 03, 2020

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

Heart failure with preserved ejection fraction ?

- May 18, 2020

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

HEART FAILURE WITH PRESERVED EJECTION FRACTION WITH CAD

- May 18, 2020

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

Heart failure with Atrial fibrillation in Elderly female

- May 16, 2020

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

HFPEF with Daibetic triopathy,HTN.

- February 12, 2020

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

Suspected heart failure with preserved ejection fraction

- August 28, 2019

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

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