48 F SOB 7 days & Pedal oedema 5 days

Im presenting a case of 48 year Female House wife ,  resident of Narketpally  came to opd with 

CHIEF COMPLAINTS 

Shortness of breath 7 days 
Pedal oedema 5 days 

HISTORY OF PRESENT ILLNESS 

Patient was apparently asymptomatic 1 week ago then she developed shortness of breath which was sudden onset Grade 3 and progressed to Grade 4 ( NYHA CLASS 4 ) 

Patient also complaining of pedal oedema B/L pitting type , which is extending upto ankle. Grade 3 

Patient also complaining of cough ,insidous onset  non productive , not associated with sputum , no diurnal variation .

H/o Orthopnea 

No H/o PND 

N/o H/o Chest pain , palpitations 

History of past illness

4 years ago 

Patient had admitted with  the similar complaints of pedal oedema & noticed deranged renal  parameters & diagnosed CKD  for which they treated symptomatically with medications 

2 years ago 

Pedal oedema & treated symtomatically with medications 

3 months ago 

Similar complaints pedal oedema & sob for which patient adviced to undergo dialysis . 

K/c/o HTN since 9 years and on medication 

Tab . Amlodipine 5mg OD 

Not k/c/o DM,Thyroid disorders ,BA ,CVA,CAD, Epilepsy ,TB.


PERSONAL HISTORY:

Diet – Mixed

Appetite – Normal

Sleep – Decreased

Bladder & Bowel movements – Regular


GENERAL PHYSICAL EXAMINATION 

Patient was concious coherent cooperative 

Well oriented to time place person 

Moderately build and nourished

 Pallor present 

No Icterus

Pedal oedema present 

No cyanosis 

No clubbing 

No koilonychia 

No lymphadenopathy 

JVP - Raised 


VITALS

Temperature – Afebrile ( 98.6 F )

Pulse rate – 85 bpm , regular 

Respiratory rate – 26 cpm

BP – 180/100 mm Hg 

SPO2 – 98% on room air  

GRBS – 176 mg/dl

SYSTEMIC EXAMINATION

CARDIOVASCULAR SYSTEM

INSPECTION 

Chest is elliptical ,  bilaterally symmetrical.

Trachea appears to be central 

Movements are equal bilaterally

JVP:Raised 

Visible epigastric pulsations 

 No scars or sinuses

Apical impulse seen in 6th intercostal space lateral to midclavicular line

PALPATION

All the inspectory findings are confirmed 

Trachea is central 

Apical impulse felt at 5th intercostal space lateral to midclavicular line.

AUSCULTATION 

S1 S2 heard no murmurs 

RESPIRATORY SYSTEM 

INSPECTION

Chest is elliptical shaped,

bilateral symmetrical.

Trachea is central 

Movements are equal bilaterally

No scars or sinuses

Apical impulse is not seen

PALPATION

All inspectory findings are confirmed: Trachea is central, movements equal bilaterally.

 Antero-posterior diameter of chest >Transverse diameter of chest

Apex beat felt in 6th intercostal space lateral to midclavicular line 

PERCUSSION

Resonant note heard in all  areas bilaterally

AUSCULTATION

Bilateral air entry present – Normal vesicular breath sounds heard


PER ABDOMEN

INSPECTION 

Shape of abdomen appears to normal

No Visible epigastric palpations 

No engorged veins sinus scars

PALPATION 

All inspectory findings conformed

Abdomen soft & Non tender

No organomegaly

PERCUSSION 

Tympanic note heard all quadrants abdomen

AUSCULTATION

Bowel sounds heard

CENTRAL NERVOUS SYSTEM

HMF - Intact 

Speech – Normal 

No Signs of Meningeal irritation 

Motor and sensory system – Normal 

Reflexes – Normal 

Cranial Nerves – Intact 

Gait – Normal

Cerebellum – Normal  

GCS Score – 15/15

Clinical pictures








Investigations 

At the time of admission






On 23/08/2023 

After 1st Dialysis


On 24 /08/2023
After 2nd dialysis


25/08/23 


26/08/2023








Provisional diagnosis 

High output Heart failure ( anemia ) 
Chronic kidney disease 




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