70-year-old female patient with Heart Failure
70 year old female with Heart Failure
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70 year old female patient, from suryapet, joke maker by occupation was brought to the hospital with c/o of Generalized body swelling since 1 month
Abdominal distention since 1 month
SOB on exertion since 1 month
Patient was apparently asymptomatic 6 years back, the one day as she was having her food, while walking to wash her hands, she suddenly felt giddy and fell down, following which she was taken to a near by RMP and referred to a higher center, where she was diagnosed with a right femur fracture and denovo hypertension.
Then she was taken to a near by quack and a pop cast was applied to her leg i/v/o the fractured femur. Her fracture healed well. She was put on anti hypertensive drugs, which she used only for 1 month, after which she stopped talking the medication.
Now, since 1 month she has developed generalised body swelling, pitting type, associated with distention of abdomen, SOB on exertion and loss of apetite.
No h/o any chest pain, palpitations, giddiness
Patient is not a k/c/o DM, CKD, CVA
Pt is c/c/c
Vitals at admission :-
BP - 100/70 mm Hg
PR - 88 bpm
Temp - afebrile
RR - 18 cpm
Spo2 - 96% RA
CVS - S1,S2 + , esm +,
RS - BAE +
P/a - soft, non tender, distended
CNS - no FND, GCS - 15/15
Diagnosis:-
Heart failure with reduced ejection fraction with severe Lv dysfunction (lvef - 25 %) with TR+, MR+, PAH, secondary to hypertensive heart disease (chronic pressure overload) , k/c/o hypertension, With ascites with fibroid uterus
DAY1
VITALS :-
Pt is c/c/c
BP - 140/90 mm Hg
PR - 84 bpm
RR - 18 cpm
Spo2 - 97 RA
CVS - S1, S2 +; ESM +
RS - BAE +
P/A - soft, NT, BS +
CNS - no FND
TREATMENT :-
1. Inj LASIX 40 mg iv /od
2. Inj optineuron 1 amp in 100 ml ns /iv/ od
3. Tab. Ramipril 2.5 mg po/od (2 pm)
4. Met - xl 12.5 mg po/od (9am)
5. Salt and fluid restriction
6. Daily weight and abdominal girth monitoring
7. BP/ temp/ pr monitoring
8. Strict i/o charting
Day 2
VITALS :-
Pt is c/c/c
BP - 140/90 mm Hg
PR - 82 bpm
RR - 16 cpm
CVS - S1, S2 +; ESM +
RS - BAE +
P/A - soft, NT, BS +
CNS - no FND
TREATMENT :-
1. Inj LASIX 80 mg - x - 40 mg /iv/bd
2. Inj optineuron 1 amp in 100 ml ns /iv/ od
3. Tab. Ramipril 2.5 mg po/od (2 pm)
4. Met - xl 12.5 mg po/od (9am)
5. Salt and fluid restriction
6. Daily weight and abdominal girth monitoring
7. BP/ temp/ pr monitoring
8. Strict i/o charting
Day 3
VITALS :-
Pt is c/c/c
BP - 110/80 mm Hg
PR - 84 bpm
RR - 15 cpm
CVS - S1, S2 +; ESM +
RS - BAE +
P/A - soft, NT, BS +
CNS - no FND
TREATMENT :-
1. Inj LASIX 80 mg - x - 40 mg /iv/bd
2. Inj optineuron 1 amp in 100 ml ns /iv/ od
3. Tab. Ramipril 2.5 mg po/od (2 pm)
4. Met - xl 12.5 mg po/od (9am)
5. Salt and fluid restriction
6. Daily weight and abdominal girth monitoring
7. BP/ temp/ pr monitoring
8. Strict i/o charting
Day 4
VITALS :-
Pt is c/c/c
BP - 150/90 mm Hg
PR - 86 bpm
RR - 16 cpm
CVS - S1, S2 +; ESM +
RS - BAE +
P/A - soft, NT, BS +
CNS - no FND
TREATMENT :-
1. Inj LASIX 80 mg - x - 40 mg /iv/bd
2. Inj optineuron 1 amp in 100 ml ns /iv/ od
3. Tab. Ramipril 2.5 mg po/od (2 pm)
4. Met - xl 12.5 mg po/od (9am)
5. Salt and fluid restriction
6. Daily weight and abdominal girth monitoring
7. BP/ temp/ pr monitoring
8. Strict i/o charting
Day 5
VITALS :-
Pt is c/c/c
BP - 130/80 mm Hg
PR - 88 bpm
RR - 17 cpm
CVS - S1, S2 +; ESM +
RS - BAE +
P/A - soft, NT, BS +
CNS - no FND
TREATMENT :-
1. Tab. RAMIPRIL 2.5 mg/po/od (@2 pm)
2. Tab. MET -XL 25 mg/po/od (@9am)
3. Tab. DYTOR 10 mg/po/od
4. Salt and fluid restriction
Day 6
VITALS :-
Pt is c/c/c
BP - 140/90 mm Hg
PR - 85 bpm
RR - 16 cpm
CVS - S1, S2 +; ESM +
RS - BAE +
P/A - soft, NT, BS +
CNS - no FND
TREATMENT :-
1. Tab. RAMIPRIL 2.5 mg/po/od (@2 pm)
2. Tab. MET -XL 25 mg/po/od (@9am)
3. Tab. DYTOR 10 mg/po/od
4. Salt and fluid restriction
Day 7
VITALS :-
Pt is c/c/c
BP - 140/90 mm Hg
PR - 77 bpm
RR - 16 cpm
CVS - S1, S2 +; ESM +
RS - BAE +
P/A - soft, NT, BS +
CNS - no FND
TREATMENT :-
1. Tab. RAMIPRIL 2.5 mg/po/od (@2 pm)
2. Tab. MET -XL 25 mg/po/od (@9am)
3. Tab. DYTOR 10 mg/po/od
4. Salt and fluid restriction
2d echo
EKG
Pedal edema
Abdominal distention
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