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How to treat breathing difficulty and swollen feet in CHF patient?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

The patient is a 64-year-old male. He has a heart condition confined with a diagnosis of CHF, and CVA infarct. He is now experiencing difficulty in breathing and swollen feet. He is currently taking Carvedilol, Aspirin, Furosemide, Captopril, and Atorvastatin (old prescription). BP ranges 140/120 mmHg. Please advise.

Hello,

Welcome to icliniq.com.

He suffers from congestive heart failure and is taking medicines for that. You did not tell dosages of medicines. His reports show (attachment removed to protect patient identity) that he also has raised creatinine and urea levels which may be due to varied causes. It may be due to reduced blood supply to kidneys due to heart failure or may be due to over diuresis. Or it may be due to any angiography or angioplasty done in the past. Or even it may be due to intrinsic renal problem. He has shortness of breath and swollen feet, which means he suffers from left and right ventricular failure, but you did not send her echocardiography and did not tell the ejection fraction.

The Probable causes

The probable causes are left and right ventricular failure.

Investigations to be done

Do echocardiography (ECG), NT-Pro BNP (B-type natriuretic peptide), and urine D/R.

Probable diagnosis

The probable diagnosis is biventricular failure.

Treatment plan

Admission to HDU or ward as oxygen may be needed. Increase the dose of Furosemide preferably intravenous dose. Monitoring intake and output. Take oral Indapamide, it also increases urine output. If renal function is deteriorating then stop Captopril and start Hydralazine 50 mg thrice a day plus Isosorbide dinitrite 20 mg thrice a day.

Preventive measures

Avoid excessive liquid intake. Avoid excessive salt intake. Avoid NSAIDs (non-steroidal anti-inflammatory drugs) such as Ibuprofen, Diclofenac (painkillers). Avoid steroids. Avoid sleeping in flat position rather adopt propped up position at 45 degrees.

Regarding follow up

Follow up after five days.

Medically reviewed byDr. Vinodhini J.

Published At July 28, 2020
Reviewed AtNovember 27, 2024

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