70 year old female came with chief complaints of shortness of breath since 5 days
















 C/o shortness of breath since 1 week

C/o generalised weakness since 1 week 

Pt was apparently asymptomatic 1 week back then she developed shortness of breath , grade 2, aggregated on exertion , gradually progressed to grade 4 .

H/ o orthopnea present , no PND.No seasonal variation,no diurnal variation.No h/o fever,cold,cough.no weight loss.no pedal edema.

Past history:

K/c/o HTN 

K/c/o HFrEF

Not a k/c/o Dm2,CVA,CAD,epilepsy


Personal history:

Diet: vegetarian 

Apetite: decreased

Bowel and bladder: regular

Sleep: disturbed 





GENERAL EXAMINATION:

Patient is conscious,coherent and cooperative, moderately built and malnourished

Pallor: absent

Icterus: absent

Cyanosis: absent

Clubbing: absent

Lymphadenopathy: absent

Pedal edema: present


VITALS:

Temperature: 98 .2F

Pulse: 124beats/minute

Blood pressure:120/80mm Hg

Respiratory rate:20cpm


Systemic examination 


CVS - S1 S2 heard

R/S - 

No wheeze 

Diffuse crepts present

no palpable mass,

Trachea- central

Vesicular breath sounds heard


P/A - 

Scaphoid,Umbilicus inverted , No abdominal distention,no  visible pulsations,scars and swelling

Soft, non tender, no organo megaly

BOWEL SOUNDS HEARD

CNS - NO focal deficit found.











Ecg at admission 




Ecg after 6 hrs


Ecg within 15 mins changes

Usg abdomen



2D echo


Diagnosis:HFrEF,new onset ?AWMI ,Anaemia secondary to ckd,grade 3 uterovaginal prolapse


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