A 63 yo Male with Pedal Edema, SOB and Scrotal Swelling

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CHIEF COMPLAINTS:

A 63 year old male came to OPD with chief complaints of:

  • Pedal edema since 3 months
  • Shortness of breath since 3 months(grade 2 to grade 3)
  • Scrotal swelling since 1 month

HISTORY OF PRESENT ILLNESS:

  • Patient was apparently asymptomatic 3 months back 
  • Then he developed b/l pedal edema(pitting type) for which he went to near by RMP and got medication 
  • Followed by which he had shortness of breath (grade 2 to grade 3)
  • No c/o Orthopnea, PND, chest pain, Palpitations
  • C/o Scrotal swelling (painless) 

HISTORY OF PAST ILLNESS:

Not a known case of DM/HTN/Asthma/TB

TREATMENT HISTORY:

Not significant

PERSONAL HISTORY:

  • Diet: Mixed 
  • Appetite: Normal
  • Bowel & Bladder: Regular
  • Addictions: Alcoholic since 25 years, Non-smoker
FAMILY HISTORY:

Not significant


GENERAL EXAMINATION:

  • No Pallor
  • No icterus 
  • No cyanosis 
  • No clubbing 
  • No lymphadenopathy
  • Edema of feet: present (b/l up to knee)

Vitals:

  • BP: 80/60 mm Hg
  • PR: 98bpm, irregular
  • SpO2: 96% on RA
  • GRBS: 142mg%

CVS:

  • S1,S2 Heard, no thrills and murmurs
  • JVP increased
  • Apex beat: 7th intercostal space(lateral and outward to midclavicular line)
  • Parasternal heave present (grade 2)



RS:

  • NVBS heard,
  • Dyspnea present (grade 3 to grade 4)

Abdomen:

  • Shape of abdomen: Scaphoid
  • Tenderness: Present in Rt Hypochondrium

CNS:

NAD


PROVISIONAL DIAGNOSIS:

  • HF with rEF with EF~20%
  • DCMP with Global Hypokinesia
  • (?) Persistent A. Fibrillation with RVR

INVESTIGATIONS:
1. Chest X-Ray



2. ECG









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