49 yrs old male with HF and CKD

 Chief complaints


Right lower limb swelling since 10 days, fever since 5 days


History of presenting illness


Patient was apparently asymptomatic 10 years back then he developed progressive swelling of right lower limb and diagnosed with filariasis for which he was prescribed medicines by a local doctor


10 year back he was diagnosed with diabetes mellitus and hypertension and since then using antihypertensives( nifedipine) and anti diabetics( glizide)


- 3 years back he developed pedal oedema and went for further evaluation and diagnosed to have chronic renal failure ?


- 2 years back he suffered from COVID-19 following which he had shortness of breath at rest (grade 4) and chest pain for which he went to co-operate hospital in Hyderabad and diagnosed to have inferior wall myocardial infarction, So he was treated with streptokinase. At that time coronary angiogram was not done in the view of high serum creatinine levels


- After 1 month coronary angiogram was done to recanalized the right coronary artery, later he had many episodes of SOB(grade 4) and diagnosed with severe heart failure and hydralazine four times a day


- since 10 days they is swelling of Right lower limb with no local rise of temperature and fever since 5 days


Daily routine:-

Wakes up at 5am 

walking for 1hour

breakfast - 7.30

Goes to work- 8am

1pm - lunch

4.30pm- tea

6pm - home

8pm - dinner

___Used to have Alcohol- occasionally but stopped since 4 years 


Fluid thrill absent


Liver not palpable .


Spleen not palpable 


Kidneys not palpable 


Lymph nodes not palpable 


PV examination -normal 


P/R examination -normal  


CNS EXAMINATION: 


Conscious 

Speech normal

No signs of meningeal irritation 

Cranial nerves: normal

Sensory system: normal

Motor system: normal

Reflexes: Right. Left. 

Biceps. ++. ++

Triceps. ++. ++

Supinator ++. ++

Knee. ++. ++

Ankle ++. ++

Gait: normal


Investigations 








Provisional diagnosis:-

Heart failure with CKD 


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