HomeAnswersCardiologycongestive heart failureWhat is the cause for CHF and CVA infarct?

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

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At July 28, 2020
Reviewed AtJune 27, 2023

Patient's Query

Hello doctor,

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, 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) 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 means he suffers from the left and right ventricular failure, but you did not send her echocardiography and did not tell 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), urine D/R.

Probable diagnosis

The probable diagnosis is 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. 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.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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