Patient is a 64-year-old male. He has a heart condition confined with a diagnosis CHF, and CVA infarct. He is now experiencing difficulty in breathing and swollen feet. He is currently taking Carvedilol, Aspirin, Furosemide, Captopril, Atorvastatin (old prescription). BP ranges140/120. Please advise.
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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) 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/plasty done in the past. Or even it may be due to intrinsic renal problem.
He has shortness of breath and swollen feet means he suffers from the left and right ventricular failure, but you did not send her echocardiography and did not tell ejection fraction.
Left and right ventricular failure.Investigations to be done:
Echocardiography (ECG), NT-Pro BNP (B-type natriuretic peptide), urine D/R.Probable diagnosis:
Biventricular failure.Treatment plan:
Admission to HDU or ward as oxygen may be needed. Increase dose of Furosemide preferably intravenous dose. Monitoring Intake and output
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.
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.
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