A 35 year old male with complaints of shortness of breath and pedal edema.

 35 year old male with complaints of shortness of breath and pedal edema.
 
I have been given this case to solve in an attempt to understand the topic of "patient
Clinical Data analysis"to develop my competency in reading and comprehending clinical data including history,clinical findings,investigations and diagnosis with a treatment plan.

You can find entire patient clinical problem in the link here :https://madhur116.blogspot.com/2020/05/on-1452020.html?m=1

Chief complaints:
1) Shortness of breath since 2 weeks
2) Swelling of both legs since 2 weeks
3) Generalised weaknesses since 2 weeks
4) Fever 1 back
Complaints in detail
Shortness of breath
Intially According to NYHA grade 3 but after treatment SOB grade 2.
Associated with Paroxysmal Nocturnal dysnea
Causes of SOB:
* CVS
* Respiratory problems
*Severe anemia
*Anxiety disorders
* Poisoning ( salicylates, ethylene glycol)
* Obesity
Ruling out the causes:
*Respiratory system - no associated symptoms like cough ,wheeze and hemoptysis
*Severe anemia - pallor is absent
*No history  of Poisoning
* Anxiety disorders - no psychological problems
* No obesity  
So the probable cause of SOB is CVS.
Swelling of both legs :
Type - pitting
Progressive in nature
Site - swelling of both legs extending up to knee
Grade 2
Causes of pedal edema:
* CVS
* Hepatic cause - cirrhosis or ascites
* Kidney damage
* Filariasis
* Deep vein thrombosis
* Thrombophlebitis
* Drugs - NSAIDs, steroids
Ruling out the causes:
*Hepatic - mild ascites on examination is present 
* Renal failure - no h/ o of oliguria, hematuria ,facial puffiness.
* No h/ o of  filariasis 
* Deep vein thrombosis - no h/ o of pain
* No h/ o of usage of NSAIDs , steroids
So,the probable cause of bilateral pedal edema is CVS.
Generalized weakness:
* Hypoglycemia
* Thyroid disorders
* Anemia
* Shock 
* Phycological problems - depression or anxiety 
* Congestive heart failure
* Vitamin B12 deficiency
Ruling out the causes:
* Hypoglycemia - FBS is normal
* Thyroid - thyroid function test???
* Anemia - no pallor
* Shock - no cold clammy skin,no feeble pulse, normal BP
*No evidence of depression and anxiety problems
* Vitamin B12 levels- ???
So,the probable cause of generalized weakness is congestive heart failure.
Fever:
Associated with chills
High grade
Treatment taken - antimalarials drugs 

Investigations:
2D echo findings
.EF - 27%
.all chambers dilated
.severe LV dysfunction
. mild TR
.severe MR
. trivial AR
.IVC dilated but no collapsing
USG abdominal findings
Grade 1 fatty liver
Right moderate pleural effusion
Mild ascites
Postprandial blood glucose - 205 mg/ do??? - diabetes ??
Raised JVP



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