AORTIC REGURGITATION WITH FAST VENTRICULAR RATE HEART FAILURE WITH MIDRANGE EJECTION FRACTION K/C/O HTN SINCE 10 YRS LOWER RESPIRATORY TRACT INFECTION (RESOLVING)

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70YR OLD MALE WITH C/O COUGH SINCE 2 WEEKS

C/O FEVER SINCE 2 WEEKS

C/O BREATHLENESS SINCE 10 DAYS

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC 2 WEEKS AGO THEN HE HAD FEVER ,LOW GRADE WITH NO CHILLS AND RIGORS MAINLY DURING EARLY MORNING AND NIGHT TIME , RELIVED ONLY TEMPORARLIY ON MEDICATION ASSOCIATED WITH COUGH WITH YELLOW SPUTUM , COUGH PRESEN THROUGHOUT THE DAY WITH NO DIURINAL VARIATION.SPUTUM IS LARGE IN AMOUNT , YELLOWISH WHITE COLOUR NON FOULSMELLING WITH SOB SINCE 10 DAYS WHICHIS PRESENT ON LESS THAN ORDINARY ACTIVITY , AGGREVATED ON EXERTION , RELIVED ON REST

PALPITATIONS,ORTHOPNEA,PND PRESENT

NO PEDAL EDEMA OR DECRESEAD URINE OUTPUT

PROFUSE SWEATING PRESENT

NO C/O LOOSE STOOLS,VOMITINGS,PAIN ABDOMEN

CHESY PAIN PRESNT AFTER EXCESSIVE COUGHING

PAST HISTORY:

K/C/O HTN AND HEART FAILURE , AORTIC REGURGITATION SINCE 3 YEARS

N/K/C/O CVA,CAD,TB,ASTHMA,THYROID AND SEIZURE DISORDER

GENERAL EXAMINATION

PT IS CCC

NO SIGNS PALLOR, ICTERUS,CYANOSIS,CLUBBING

TEMP 98 F

PR 101 BPM

RR 16 CPM

BP 130/80 MM HG

SPO2 98 @ RA

GRBS 120 MG/DL

CVS S1 S2 HEARD

RS BAE +

GIT SOFT NT

CNS NFND

INVESTIGATION:

POST LUNCH BLOOD SUGAR   16-12-2023 04:15:PM 116 mg/dl 140-0 mg/dl	RFT   16-12-2023 04:15:PM   UREA 35 mg/dl 50-17 mg/dl  CREATININE 1.1 mg/dl 1.3-0.8 mg/dl  URIC ACID 6.3 mg/dl 7.2-3.5 mg/dl  CALCIUM 9.8 mg/dl 10.2-8.6 mg/dl  PHOSPHOROUS 3.4 mg/dl 4.5-2.5 mg/dl  SODIUM 139 mEq/L 145-136 mEq/L  POTASSIUM 4.0 mEq/L 5.1-3.5 mEq/L  CHLORIDE 101 mEq/L 98-107 mEq/L
LIVER FUNCTION TEST (LFT)   16-12-2023 04:15:PM   Total Bilurubin 1.22 mg/dl 1-0 mg/dl  Direct Bilurubin 0.44 mg/dl 0.2-0.0 mg/dl  SGOT(AST) 19 IU/L 35-0 IU/L  SGPT(ALT) 11 IU/L 45-0 IU/L  ALKALINE PHOSPHATE 115 IU/L 119-56 IU/L  TOTAL PROTEINS 7.1 gm/dl 8.3-6.4 gm/dl  ALBUMIN 4.0 gm/dl 4.6-3.2 gm/dl  A/G RATIO 1.33	HBsAg-RAPID   16-12-2023 04:15:PM Negative
Anti HCV Antibodies - RAPID   16-12-2023 04:15:PM Non Reactive	COMPLETE URINE EXAMINATION (CUE)   16-12-2023 04:15:PM   COLOUR Pale yellow    APPEARANCE Clear    REACTION Acidic    SP.GRAVITY 1.010    ALBUMIN Nil    SUGAR Nil    BILE SALTS Nil    BILE PIGMENTS Nil    PUS CELLS 2-3    EPITHELIAL CELLS 2-3    RED BLOOD CELLS Nil    CRYSTALS Nil    CASTS Nil    AMORPHOUS DEPOSITS Absent    OTHERS Nil
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   18-12-2023 05:47:PM   SODIUM 138 mEq/L 145-136 mEq/L  POTASSIUM 4.5 mEq/L 5.1-3.5 mEq/L  CHLORIDE 103 mEq/L 98-107 mEq/L  CALCIUM IONIZED 1.09 mmol/L mmol/L	SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   18-12-2023 09:27:PM   SODIUM 140 mEq/L 145-136 mEq/L  POTASSIUM 4.5 mEq/L 5.1-3.5 mEq/L  CHLORIDE 104 mEq/L 98-107 mEq/L  CALCIUM IONIZED 1.22 mmol/L mmol/L

2D ECHO

NO RWMA CONCENTRIC LVH

CALCIFIED AV

MILD MR , MILD TR WITH PAH

SEVERE AR

MAC +

THICKENED MV

MODERATE AS

EF 65%

GOOD LV SYSYTOLIC FUNTION

DILATED LA/LA/RA

IVC 1.09 CM COLLAPSING

AORTA DILATED

DIAGNOSIS:

AORTIC REGURGITATION WITH FAST VENTRICULAR RATE

HEART FAILURE WITH MIDRANGE EJECTION FRACTION

K/C/O HTN SINCE 10 YRS

LOWER RESPIRATORY TRACT INFECTION (RESOLVING)

TREATMENT:

FLUID RESTRICTION <1.5 LIT/DAY

SALT RESTRICTION <1.5 LIT/DAY

TAB DYTORPLUS 10 MG PO/BD

TAB MET XL 25 MG/PO/OD

TAB ECOSPIRIN AV 75/20MG/PO/HS

TAB DYTOR PLUS 5MG /PO/OD

INJ MONOCEF 1 GM IV BD

TAB PAN 40 MG PO/OD

INJ NEOMAL 1GM IV SOS

TAB DOLO 650 MG PO/SOS

TAB TELMA 40MG PO OD

TAB MONTAC LC ON SOS

SYP GRILLINCTUS 10ML PO HS

ADVICE AT DISCHARGE:

TAB DYTORPLUS 10 MG PO/BD 8AM

TAB MET XL 25 MG/PO/OD 8 AM

TAB ECOSPIRIN AV 75/20MG/PO/HS 9AM

TAB DYTOR PLUS 5MG /PO/OD 4 PM

TAB PAN 40 MG PO/OD X 3 DAYS 7 AM BEFORE BREAK FAST

TAB DOLO 650 MG PO/SOS

TAB TELMA 40MG PO OD 8 AM

TAB MONTAC LC ON SOS X 3 DAYS

SYP GRILLINCTUS 10ML PO HS X 3 DAYS