60 yr female with dilated cardiomyopathy with HFrEF.

A 60 year old female who is a vegetable seller from Aravapally presented to casualty with  c/o dyspnea from one week, dry cough from one week and fever from two days.

HOPI

Patient was apparently asymptomatic 20days back then she developed generalised weakness because of which she couldn’t do her routine duty.

She has history of dyspnea one week back which was initially of grade 2 and later progressed to grade 4 within 3 days for which she was admitted to a government hospital, treated for URTI and  discharged in 3 days after relief of her symptoms. 

During this time, she had dyspnea on exertion with excessive sweating which was progressive, increased on lying down, aggravated on walking and relieved with rest. 

H/o Orthopnea and PND.

RAT was Negative.

Now she came with complaints of dry cough from one week, dyspnea from yesterday which is aggravated on lying down and relieved on sitting/rest.

H/o fever from 2 days, low grade, intermittent and not a/w chills.

No h/o chest pain.

No h/o palpitations, sweating, pedal oedema.

No h/o decreased urine output.

PAST HISTORY:

K/C/O DM from 10 yrs, on Tab.Metformin.  

Patient was admitted to a private hospital for uncontrolled sugars and blisters on abdomen 10 yrs back.

Not a k/c/o HYPERTENSION.

No h/o smoking,alcohol ,tobacco chewing.

 

GENERAL EXAMINATION 

Patient is conscious, coherent, cooperative and oriented to time,place,person.

Central obesity present.

JVP is elevated.

Pallor is seen. No icterus,cyanosis, clubbing, lymphadenopathy, pedal oedema.

Weight-64kgs

Height-149cm

BMI-28.8kg/sq.m

VITALS:

BP 140/90 mmhg

PR 101 bpm

Spo2 98% @ room air 

Grbs 226 mg/dl 

RR 30 / min @ admission 

SYSTEMIC EXAMINATION:

CVS: S1 S2 heard. 

R/S: BAE +. Coarse crepts in left inframammary area.

P/A: Obese, umbilicus central inverted, scar present on the left lower abdomen, no sinus, no engorged veins. Soft, non tender.

INVESTIGATIONS:

        

ECG

2D

ECHO

CXR

DIAGNOSIS:

Dilated cardiomyopathy with HFrEF with Type 2 Diabetes Mellitus.

TREATMENT:

INJ. LASIX 40MG IV/BD.

TAB. MET-XL 25MG PO/OD.

TAB.ECOSPIRIN 75/20 PO/OD

TAB.RAMIPRIL 5MG PO/OD.

INJ. HAI TID.

SALT RESTRICTED DIET.

FLUID RESTRICTION.

2 days after admission, she developed weakness of left hand and inability to flex and extend her fingers on left hand. 

MRI Brain

Diagnosis

Dilated cardiomyopathy with HFrEF with Diabetes Mellitus with CVA with acute infarcts with haemorrhage in right frontal lobe.

1)To reduce preload and afterload .

(inj.lasix40mg iv /BD , Tab.Ramipril 5mg /po/OD)

Tab Met XL 12.5mg /PO/OD

2)blood sugar control (T.METFORMIN 500mg/PO/OD and inj Actrapid insulin )

3)physiotherapy of left hand.

On neurologist opinion- 

Physiotherapy of hand.

Tab.Ecosporin 15mg OD

Anticoagulants after 2 week.