K/c/o HTN (on amlodipine) K/c/o DM (on insulin inj ) K/c/o IHD - Rx PCI ć stent Smoker - 60 pack years - COPD+ Left alcohol since 15 years Came now with c/o bilateral limb swelling , breathlessness(Grade 3 NYHA ) and Dry cough H/o orthopnea H/o slipping of chappals + (neuropathy+) O/e . • perception of light -Left eye • right eye operated 3 years back , shining reflex + Pupils reactive • JVP >8 (elevated ) •PR : 80 , RR: 24 (no accesory muscles used ) , BP:160/100 . • hands ?! Any finding ?? • chest : CVS - Apex beat shifted out and down (6th IC ) S1S2 heard , no murmurs RS - B/l creps at axillary and infrascapular area . • abdomen -NAD • LL: pitting pedal edema extending upto knee . Feet - any other finding ???! CXR - cardiomegaly ¿ Any other relevant findings in hands/ feet or CXR ?! Opinions ?!?!

(Edited)

5 Likes

LikeAnswersShare

Rt eye operated 3 yr back for cataract with shining reflex Lt eye perception of light due to cataract need to examine projection of light , intraocular pressure and macular functio test before deciding any surgery Other systemic condition of COPD, Cogestive heart failure, left ventricular hypertrophy as apex beat is down & out with creps and pedal oedema , diabetes are to be looked by cadiologist and endocrinologist. When patient is fit may be operated for cataract lt eye

Thank you doctor
0

Tinea pedis with Onychomycosis COPD CCF

And also ingrowing of great toe nail
0

View 1 other reply

Diabetic and d.neuropathy has started due to long term DM S/s r of CCF Echo Start diuretic Consult endocrinologist for DM and cardiologist for ccf

2D Echo will be conclusive. Look for peripheral lower limb arterial pulses viz.dorsalis pedis & post.tibials to R/o TAO. Stop Amlodepin,& start ARB+ diuretic (Telmasarten + Hydrochlor thiazide) Also startTab.Eparal 50mg 1 TDS it will take care of pedal diabetic neuropathy.

Thank you doctor
0

Emphysema Copd

Tnx
0

View 1 other reply

Congestive cardiac failure due to ischemic dilated cardiomyopathy..with toad skin??.. 2D Echo , s creatinine, electrolytes, Hb Start Dytor infusion, dobutamine infusion if low ef and antiplatelets, ACEI, multivitamin injection or tabs

Thank you doctor
0

Answer to Dr. Astha Thakur's post - DIABETIC MICROANGIOPATHY AFFECTING MULTIPLE SYSTEMS AS DESCRIBED & MANY MORE, I F INVESTIGATED FURTHER WITH APPROPRIATE TESTS.

Advise CBC, LFT, KFT and TFT

It's a clear cut case of CHF, start with dytor 10 od , ace inhibitors and b blocker. For skin lesions u should ask for steroid intake( he must have ) and give MDI Foracort 2 puffs Bd

Dr rahul karimangi.congratulations.very good foag

Load more answers

Cases that would interest you