Case of the day

CAD, LV dysfunction

49F k/c/o DM2, HTN, CAD, CKD, PVOD, Post amputation left little toe(1 year back) on regular medication. No complaints since an year. Asymptomatic. patient is on following medication Cilnidipine 10 bid Arkamine 100mcg tid Carvedilol CR 10 qd Aspirin 150 qd Clopidogrel 75 qd Atorvastatin 20 qd Novomix 30 bid dose Teneligliptin 20 qd Ivabrad 5mg 1/2 bid Sorbitrate 5 tid Sobosis 500 bid Nefrosave bid iron and calcium qd ACE/ARB were withheld due to decrease in egfr and hyperkalemia.(8months back). Now Urea 48 Creatinine 1.8 FBS 130 PPBS 177 HBA1C 6.9 HB 11.2 Na 142 K 4.1 On routine checkup ECG and Echo were repeated. Reports attached. Patient is asymptomatic. Physical examination is WNL. PR 83 bpm Bp 130/80 mm hg Kindly give your opinion on further management.

(Edited)
LikeAnswersShare
Good management . 1) Double antiplatelets are usually contraindicated in CKD. But if CABG or Coronary angioplasty and stenting has been done, they are indicated for a limited period of 6 months to one year. 2) Theoretically, SGLT 2 inhibitors have a place in this setting of CKD and systolic dysfunction( EF 40%) to prevent worsening and prevent hospitalisation or dialysis. This concept is now getting extended to non diabetic CKD and cardiac failure. Treating physician should decide on this. 3) Combination of beta blockers and ivabradine is risky ,since it can produce blocks. This patient's pulse rate is 83. Needs frequent watching . 4) Arterial color doppler of lower limb can be done, in view of the amputation to check for vascularity. 5) Thyroid profile and VIT D3 levels may be checked.
Thank you, Doctor
0

View 3 other replies

Pt has multiple comorbidies Given figures suggest he is stable And as low egfr ckd hence present levels of Kfts are acceptable Bsl is more less in fair control some more control is possible by insulin Cardiac performance is lt axis LBBB/LAD needs monitoring Keep followup My question is the pt is on dual antiplatelets So also on carvidol than why he is getting IVABRADINE?
Valuable opinion
1

View 1 other reply

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
Thank you
1
ECG = LVH WITH STRAIN ECHOCARDIUM = RWMA + FEW CLARIFICATION 1 HE HAS PERIPHRAL ARTERIAL DISEASE UNDERWENT AMPUTATION LEFT LITTLE TOE SHOULD WE CONTINUE BETABLOCKER ? 2 TENELIGLIPTIN 20 QD ? POSSIBLY PRINTING MISTAKE WE CAN REPLACE TO DAPAGLIFLOZIN 5 MG OD IN PRESENCE OF RWMA 3 BLOOD P0 3/ 4 INTACT PARATHORMONE TO EXCLUDE SECONDARY HYPER PARATHYROIDISM BLOOD ERYTHROPOITEN LEVEL SERUM IRON FERRITIN 4 NEFROSAVE IS IT A NECESSARY DRUG ?
Thank you sir for clarifications @Dr. Samir Kr Bhattachsrya 1. Beta blocker is being continued to decrease myocardial oxygen demand, heart rate and prevent arrythmia as patient has CAD/Mod LV dysfunction. 2. Is it recommended to initiate SGLT2 inhibitor at egfr 30 ml/min/1.73 m2??? Teneligliptin is being used as it is safe in CKD. 3. PTH, Calcium, Phosphate, Vit D levels were checked 6 months back. Will repeat again. 4. Taurine has many protective effects on kidney in particularly diabetic nephropathy. Although its use in CKD is debatable. NAC use was associated with reduced risk for progression to ESRD requiring dialysis. I would like to know your opinion further. Thankyou sir.
0
cap lipostat 2-2 hradayamrit vati 1-1 prabhakar vati2-2 arogya vardhani vati2-2 punarnarvamandur2-2 cap lasuna 2-2 hingu du uttar churan 3gm arjunarishta 10 ml dashmularishta 10 ml loki juce30 ml bd jawahar mohra pishti 125 mg bd 2 months ke liye trikatu kwath tds
ECG shows... Widespread st depression in the chest leads.... Lvh With strain? As per RX concerned vasodilator could be added .
Valuable opinion
0
Punarnava+gokshur+kutki churna(Gfr may increase by rx) Tab chandrprabha 2bd Next rx after 7day's thanks
LVH with strain St depression in v3 v4 is of Ischemic in nature Do Troponin level
sinus rythm normal ecg LA dilated mild TR,Mild MT moderate LV dysfunction
Go for routine coronary angiography
Valuable opinion
0
Load more answers

Cases that would interest you