A 58 year old man presented with shortness of breath

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N Akshaya

Rollno 197 

A 58 year old man ,labourer by occupation, came to the OPD with the chief complaints of Shortness of breath since 2 weeks , worsened 3 days back, facial puffiness since 1 week

History of Presenting illness - 

Patient was apparently asymptomatic 4 years ago

4 years ago - pt complained of giddiness, went to a local hospital and was diagnosed as Hypertensive,then they gave medication for htn   since then T. Nicardia 10mg.

2 years back Pt developed B/L pedal edema, progressed gradually to knees, he was also diagnosed with renal failure and initiated dialysis weekly twice

Left upper limb swelling, gradually progressing to current size, since 4 months . Swelling in the left chest region, gradually progressing to current size, since 4 months

Back pain since 2 months, subsided on medication .ultracet tab 

7 days back - developed Facial puffiness

Shortness of breath since 7days

No c/o palpitations, giddiness, cold, cough, burning micturition

PAST HISTORY -

Known case of Hypertension since 4years on Tab nifedipine 10mg OD

Not K/C/O TB, Epilepsy, Asthma, CAD.

 No h/o trauma,loss of weight 

No h/o fever

Personal history

Appetite- normal

Diet- mixed

Bowel movement- Regular

Alcoholic stopped 4 yrs ago

Non smoker

On examination

Pt is C/c/c

No Pallor,Icterus,Cyanosis,Lymphadenopathy

Edema of feet + 

Vitals

Pr:94bpm

Bp:120/80

Spo2:97% at RA

Temp - Afebrile

Systemic examination

CVS - S1,S2 +

RS - BAE + 

CNS - NAD

P/A- Soft, non tender

Investigations

Serology - Negative

Provisional Diagnosis - pleural effusion .

Treatment-

Fluid restriction (<1l/day)

Salt restriction (<2g/day)

T· LASIX 40 mg PO BD

T. Nicardia 100mg PO BD

T. NODOSIS 500 MG PO BD

T. OROFER-XR PO OD