Case of Heart Failure

Case of Generalized body Swelling


A 70 year old male farmer presented to OPD with

 chief complaints of Scrotal swelling since 15 days ,

 SOB since 10 days with generalized anasarca, 

Constipation since 12 days (passing stools only on 

medication )

Patient was apparently alright 1 year back 

When developed - 

Cellulitis of right lower limb (due to DM-II)


On 15/10/21 - 

He developed swelling of the right leg till the knees and

 facial puffiness, for which he visited doctor and was

 treated for the same and it subsided later on. 

On 16/10/21- 

on usg - mild left pleural effusion


On 15/11/21- 

Generalised body swelling, scrotal edema,  decreased urine

 output and after 2 days sob


ON 16/11/21- 

He visited the doctor and 

on usg -

scrotal wall cellulitis

RBS- 279

Blood urea- 97

Raised serum creatinine-3.6mg/dl 

Serum Utica acid- 7.6mg/dl

LFT- within normal range, albumin-3.5

He was treated with- 

Inj.cefaoish (cefoperazone and sulbactam)

T.metrogyl

T.dytor 10mg 

T.amlong 10mg

T.Nodosis

T.nephrosave 

Nebulisation with formonide

T.ecospirin 75mg

Inj.hai 12u———10u On 17/11/21- 

Hb- 9.4

Blood urea- 96

Serum creat- 2.6


past history

H/o RT LL CELLULITIS (due to DM-II) one year back. Got

 treated with various antibiotics (meropenem etc) and

 tramadol for pain for around 3-4 months. 


DM(+ - diagnosed 20 hrs back) ,  HTN(-)

On 16/11/21 he was told to have recovered from

 accelerated HTN


personal history

appetite-normal

addictions- none

bowel movements- was normal until 16/11/21 when he

 developed gastritis and constipation and wouldn’t pass

 stools for 4 days. And on taking medication he would pass

 stools. 

Till now (from 16/11-27/11) stools passed- 5 times.

micturition - decreased urine output since 5 days


no significant family history


general examination

pallor-present

icterus-absent 

Edema- generalised body edema (pitting type) present 

NO clubbing,cyanosis, lymphadenopathy 

pulse-85/min

Rr-19cpm

BP- 110/70 mmHg

spo2 - 98%

CVS

s1,s2 heard

RS :

BAE + ,NVBS 

P/A- soft, non-tender

No guarding or rigidity 









B/l scrotal edema (Scrotum enlarged diffusely) ; PENILE

 EDEMA +

No local rise of temperature

No tenderness, no c/o cellulitis


CNS: 

NAD


provisional diagnosis:

SOB UNDER EVALUATION WITH SCROTAL SWELLING ;

 k/c/o DM

INVESTIGATIONS- 








Diagnosis

Heart failure with left ventricular ejection fraction

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