45 year old female patient complains of fever







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Chief complaint:

49 year old female patient came to casuality with chief complaint of fever since 8 days ,sob since 5days ,cough since3 days and decreased urine output since 1 day

History of present illness:

Patient was apparently asymptomatic 8 days back then she developed  fever suddenly , intermittent and low grade fever .patient complaints of sob since 8 days and cough with sputum since 3days.

She had history of bipedal edema and facial puffiness .

History of covid vaccination 10 days back .

Past history:

She is a known case of hypertension since 1 1/2 year .

No history of diabetes mellitus ,asthama,TB.

No similar complaints in the past

Personal history:

Diet -vegetarian 

Appetite -normal 

Sleep -adequate

Bowel and bladder movements-regular

No addictions 

Family History:

No relevant family history 

Treatment history:

She had a tubectomy in the past 

Menstrual history:

Menopause at 43 years .

GENERAL EXAMINATION:

Patient was conscious,coherent ,moderate built



Clubbing:

Pallor

No cyanosis And lymphadenopathy

Vitals:

Temperature- afebrile 

RR-32cycles /min 

PR-120beats /min 

BP-110/70 mm Hg

Spo2-82%

GRBS-187mg%

SYSTEMIC EXAMINATION:

CVS :

No thrills 

S1 ,S2 heard 

No cardiac murmurs

RESPIRATORY SYSTEM:

Dyspnea -present 

Wheeze -present 

Position of trachea-central

Breath sounds -present 

Crepts are present 

ABDOMEN:

Shape of abdomen -scaphoid 

Tenderness -absent 

Palpable mass -absent 

Hernial orifices -normal

No bruits 

No free fluid 

Liver -not palpable

CNS:

Level of consciousness-conscious 

Speech -normal

No stiffness 

No kerning's sign

INVESTIGATIONS:

Hemogram:


Hb -8.2gm /dl 

Total count -13,300 cells /cumm 

Neutrophils -95%

Lymphocytes -3%

Eosinophils-1 %

PCV-22.2vol %

MCV-75.3 fl 

RBC count -2.95 millions /cu mm

Platelet count -3.41 lakhs /cu mm 

TPR GRAPH:

ECG REPORT:

PROVISIONAL DIAGNOSIS:
HFrEF Secondary to CAD 


?AKI on CKD
? cardiogenic pulmonary edema
Treatment:






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