50 yrs old a/k/c of T2DM 15 yr, on OHA, hypertensive for the past 2 yrs on treatment, presents with breathlessness on exertion, abdominal distention, Early satiety 10 days H/O PND 1 episode 15 days back no c/o orthopnea no c/o decreased output O/E facial puffiness+ b/l pitting pedal edema+ lt basal crepts+ investigation urine albumin ++ PPBS 256mg urea 38mg% creatinine 1.91mg% opinion regarding further management

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LBBB, LVH, sinus tacchycardia DM2 with nephropathy r/o LVF secondary to ischemia Adv - 2D ECHO, ABG, electrolytes HbA1c, pro BNP, 24hr urinary protein, USG KUB Rx - O2, Diuretics, ACE inhibitors, correct electrolytes and control sugar
UNCONTROLLED DM HTN DIABETIC NEPHROPATHY DIABETIC GASTROPARASIS CKD H/O PND SOB BASAL CREPTS SUGGESTIVE CHF ECG SINUS TACHYCARDIA LVH WITH DIASTOLIC OVER LOAD FURTHER PLAN BLOOD K+ Na+ Ca ++ Hco3- po 3/4 25 (OH) D RX 1 FLUID RESTRICTION 1 L / DAY 2 SALT RESTRICTION TO 3 Gm /DAY 3 DIURITICS FRUSEMIDE 40 MG BD 4 GLYCEMIC CONTROL LINAGLIPTIN 5 MG EMPAGLIFLOGIN 25 MG SHORT ACTING INSULIN SUPPLEMENTATION SOS CONTOL BP CALCIUM ENTRY BLOCKER = IF CHF IT IS TO BE AVOIDED ACE / ARB MAY BE OF CHOICE PROVIDED e GFR IS NOT BELOW 40 ML / MINUTE BETA BLOCKER MAY OF SECOND CHOICE CHLORTHALIDONE IS ALSO A GOOD CHOICE PROPP UP DECUBITUS AT 80 °
He is a c/o chr dm2t/ht though on rx but uncontrolled urine alb++ gen anasarca with dysponea. Ecg shows features of over load &lbbb .this all goes in favour of chf/crf rather multiorgan failure.so maintain spo2 give optimum doses of diuretics+lanoxin to improve cardiac output control of bsl by oha+insulin with strict monitoring .continue anti ht. Yes bedside investigations and keep monitoring
ECG- sinus tachycardia, Axis- normal, LBBB, LVH with strain pattern, tachycardia induced ischaemia. HTN+ T2DM + Nephropathy + LVF/ Cardiorenal Syndrome. Management of LVF by reducing preload and after load, reducing sympathetic activity, M.O2, etc. control of BS + s.Cholesterol, electrolyte + PH balance + management of CKD.
There is nstemi in 1,2,avl,v4-v6,lvf is a high mortality condition if not treated with minutes and hours and the history is of 10 days,so i don't think its lvf,but one point which is in favour of lvf is abdominal distension and one more point that hypertension is a most common precipitating factor of lvf but if history of 20 days,so lvf is rare,lbbb is there with sinus tachycardia
LBBB. Concurrent st t changes. LVH. DO echo. Looking like symptoms of heart failure with reduced ejection fraction. Echo will confirm it. With diabetes, CAD likely. Hypertensive leading to lvh. Diuretics to reduce preload will help. Beta blockers will also help like carvedilol. Nitrrates for reducing load. Echo needed.
Sinus tachycardia with LVH with LBBB appears to be a case of hypertensive ht disease with L V dysfunction with nephropathy cardiac echo usg kubp are needed Torsemide and nitrates will help
S.tachycardia LVH LBBB-- Modified Smith Sagarboss criteria negative so no acute mi Check LYTES, THYROID FUNCTION, HB, S.ALBUMIN LEVEL Go for Echo pt may hv DCM & due to that P.Odema
sinus tachy.Lvh rbbb avoid fluid overload.sugar control and give diureticsand adv echo angiography and cbc lft kft cpkmb and trop t
ECG: sinus tachycardia, LAD, LVH with strain
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