A 60 yr old female with facial puffiness
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A 60 year old female who used to be to a farmer came with the complaints of b/l knee joint pain since 3 years, facial puffiness since 3 months, b/l pedal edema since 1 week
History of presenting illness
Patient was apparently alright 3 years ago then she developed — b/l knee joint pain since 3 years
It is aggravated on walking and standing, relieved on taking medication and taking rest
She has been taking medication for pain frequently 3-4 days in a week both oral and injectables from local RMP
— facial puffiness since 3 months
It is present mostly during the day and reduced in the night
— b/l pedal edema since 1 week
Pedal edema is present until ankle, pitting type, it has reduced in the past 2 days
Daily routine
3 years ago: She used to work as a farmer like sowing seeds, plucking up cotton in cotton fields
Due to the b/l knee joint pain she stopped working as farmer
nowadays she does her house chores and takes rest
She wakes up at 5:30 am in the morning, does house chores like washing utensils, cooks food and eats it (rice+vegetables) in the morning at 9am and complete her remaining house chores and then she have lunch at 3 pm and takes rest, then prepares dinner and have it and sleeps at around 10pm
Most of the times she have only 2 meals a day
She drinks tea in the morning and evening when she visits her sons place but not when she is at her house
She smokes (chutta) 3 times a day, 1 chutta at a time and started smoking 2 years ago
She takes alcohol occasionally and she started taking alcohol 40 years ago
She is married at the age of 18 years
She has 5 children
Not a k/c/o HTN, DM, Tuberculosis, Thyroid disorders, asthma, epilepsy, CVA, CAD
General examination
No signs of pallor, icterus, cyanosis, clubbing, generalised lymphadenopathy
B/L pedal edema is present until ankles, pitting type
Vitals
PR- 86 bpm
RR- 18 cpm
BP- 100/70mmHg
Spo2 - 99% on RA
RS-B/L air entry present
NVBS
CVS- S1S2 present, no murmurs heard
PA- Soft,non tender
CNS: NAD
Provisional diagnosis: Heart failure with preserved ejection fraction.
Investigations:
Hb: 11.7 gm/dl
TLC: 10,700 cells/cumm
RBC: 4.33 millions/cumm
PLATELETS: 3.54 lakhs /cumm
Blood urea: 21 mg/dl
Serum creatinine: 0.9 mg/dl
Serum Na+:137 mEq/L
Serum K+:4.4 mEq/L
Serum Chloride:99 mEq/L
LFT:
Total bilirubin: 0.74
Direct bilirubin: 0.19
SGOT:14
SGPT:13
ALP: 223
Total proteins: 6.3
Albumin: 3.5
A/G Ratio: 1.32
CUE
Albumin: Nil
Sugars: Nil
Epithelial cells: 2-3/ HPF
Pus cells: 2-3/HPF
Chestxray:
1)Tab Ultracet PO/QID
2)Tab LASIX 20mg /PO/BD
3)Tab Metxyl 12.5 mg/dl PO/OD
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