50 year old female with Chronic Heart Failure

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A 50 year old female, farmer by occupation presented with the chief complaints of bilateral lower limb swelling on and off since 4 days, complaints of decreased appetite since 15 days, complaints of difficulty in breathing after eating since 15 days, complaints of nausea since 1 week. 

Patient was apparently asymptomatic 15 days back then had developed decreased appetite and had apparently developed difficulty in breathing since 15 days after eating which was associated with burning sensation in the epigastric region and bitter taste in mouth after eating food along with nausea since 1 week. 

No H/O orthopnea, PND, palpitations, SOB on exertion. 

Past history- 

• She is a K/C/O heart failure who was admitted 1 year back.
• N/K/C/O DM, HTN, TB, Asthma, CAD, CVA 

Personal History- 

• Diet- Mixed 
• Appetite- normal until 15 days ago 
• Bowel and bladder- regular 
• Sleep- adequate
• Addictions- occasional toddy intake 

Vitals- 

• Temp- afebrile 
• PR- 84 bpm 
• RR- 18 cpm 
• BP- 140/90 mmhg 
• GRBS- 102 mg/dl 

General Examination- 

• Patient is Conscious, coherent and cooperative 
• Well oriented to time, place and person 
• Lean built 
• Pallor+ 
• No Icterus, cyanosis, koilonychia, lymphadenopathy, Edema of lower limbs 

Systemic Examination- 

CVS- 

• JVP raised 
• S1S2 heard 
• Palpable P2 present 
• Pansystolic murmur heard 
• Parasternal heave felt 

RS:

•  Bilateral Air entry present 
• Normal vesicular breath sounds heard 

P/A- 

• no scars / sinus, all quadrants moving equally with respiration
• Soft, Non- Tender
• Bowel sounds heard 

CNS- 

• NFND
• HMF intact

LAB INVESTIGATIONS

• Blood Urea- 23 mg/dl
• Serum Creatinine- 1.0 mg/dl
• Serum electrolytes- 
• SODIUM -142 mEq/L
• POTASSIUM - 3.1 mEq/L
• CHLORIDE -103 mEq/L
• CALCIUM IONIZED-  1.01 mmolL

COMPLETE BLOOD PICTURE

• HAEMOGLOBIN -9.6 gm/dl 
• TOTAL COUNT -5,000 cells/ cumm
• PCV -31.4 vol% 
• RBC COUNT -3.62 millions/cumm
• PLATELET COUNT -2.43 L 

Chest X RAY: 

ECG: 

DIAGNOSIS 

Right heart failure with hypokalemia with GERD 

TREATMENT 

1. TAB. LASIX 20mg PO/BD 

2. TAB METXL- 12.5mg PO/ OD 

3. SYP. POTKLOR 10ml PO/TID

4. TAB. ZOFER PO/OD 

5. TAB. PAN-D 40MG PO/OD 

6. Monitor Vitals 

7. Avoid sleeping immediately after food