70 yo man k/c/o dm & htn since 8 yrs. recently diagnosed with diabetic retinopathy. has on & off pain & swelling in rt foot phalenges only which comes back after stopping nsaids. x-ray shows no fracture.uric acid normal. 2d echo,Doppler right lower leg & ecg was done. serum creat,hgt, hba1c,lipid profile within normal limits.please interpret ecg n correlate with Doppler study & suggest further treatment




Left axis deviation . Otherwise normal ecg . Mild atherosclerotic wall calcification. 2decho. Grade II diastolic dysfunction . . Advised 1 dash diet . Strict diabetics and htn controlled. Limb evevation . Use of stockings . Clopitab a in afternoon . Quarterly retina check up . For htn a nd diabetics changes

ecg showing LBBB,2D echo showing gd-2 DD,Doppler study of b/l lower limb arteries normal.hence the pt is having claudication pain in legs.give aspirin+clopidogrel+atorvastatin along with insulin

Claudication is unlikely with normal flow in the arteries...must be neuropathic pain

No cardiac intervention required at present.echo & Ecg both r normal.look for rheumatological disorders.

If Lipid profile and sugar levels are normal, it would be better to take Vascular surgeon opinion .

Diabetic neuropathy with ? Autonomic dysfunction. Adv NCV.

Osteoarthritis Rhematoid arthritis Gout still possible with normal uric acid levels Age favours osteoarthritis Unlilaterality of symptoms with sym more right side again favours more wear and tear osteoarthritis with local complcations, bursitis osteophytes,spurs Xray of rt foot may be of help Infections of foot...cellulitis, lymphangitis

Echocardiography and doppler study of lower limb vessels is not related to right foot pain . Get s .uric acid done .Symptoms are part of diabetic neuropathy and diabetic foot. Give NSAIDS in association with pre gabalin,methyl cobalamin, L-Carnitine and Ubiquinone. NSAIDS can be stopped after 10 days .Ensure strict diabetic control

Sorry forgot 2 mention uric acid levels were also normal

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Get his arthritis profile done with fresh Bl.sugar level,complete lipid profile.As Dr.Tarlekar n Dr.Parveen Yograj said. ...I also don't see any direct connection between foot pain n other investigations done.After the reports with tight Bl.sugar control treat OA/RA if any.

Go for C - reactive protein &ESR.Then Tt pt with cap Indocap 75mg first increasing order &then curtail in decreasing order ,not more than 20days.

This cld b osteoarthritis involving small joints Of course u must hv dobe ra factor also Check PSA ADD GLUCOSAMINE AND SEE

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