1. the breathlessness was on walking, but now he was 

breathless  even  at  rest.  

2. He  has  also noted  bilateral  leg swelling.  

3. For  the  last  two  days,  the  patient  required three pillows  to  sleep  as  his  breathlessness  becomes  worse  on lying  down.  

4. He  had  been  coughing  pinkish  frothy  sputum. 

However, there was no squeezing chest pain with radiation.

 
5. He  has  hypertension  and  hyperlipidaemia  for  the  past  ten years. 

6. He is on amlodipine 10 mg once a day and simvastatin 20 mg at night.

7. He smokes 20 cigarettes per day for the last 25 years. 

8. He  works as a lorry driver.

 

breathless  even  at  rest.  

2. He  has  also noted  bilateral  leg swelling.  

3. For  the  last  two  days,  the  patient  required three pillows  to  sleep  as  his  breathlessness  becomes  worse  on lying  down.  

4. He  had  been  coughing  pinkish  frothy  sputum. 

However, there was no squeezing chest pain with radiation.

 
5. He  has  hypertension  and  hyperlipidaemia  for  the  past  ten years. 

6. He is on amlodipine 10 mg once a day and simvastatin 20 mg at night.

7. He smokes 20 cigarettes per day for the last 25 years. 

8. He  works as a lorry driver.

FURTHER EXAMINATION
1. inspection
2. heart sound
3. vital signs
4. cardiac examination (ecg)
5. palpation

sweaty.

 

1.His vital signs were as follows:

 

Blood pressure (155/ 95 mmHg)

 - High (Stage 2)

Temperature (37°C)

 - Normal

Respiratory (30 breaths/ min)

 - High (12-16 Normal)

Pulse (110 beats/ min)

 - High

 

2.Oxygen saturation: 88% on room air (normal range: 95 

–100% on room air).

 - SpO2

3.Bilateral pitting oedema up to the knees was present.
- Pit formed after pressure
- Exudate
 4.The jugular venous pressure was raised at 7 cm. 
- Discuss LO nanti
5.The apex beat was at the 6th intercostal space at the mid

clavicular line.
- Heart hypertrophy
 6.There were crepitations heard over the posterior lung bases posteriorly.
-Pulmonary Oedema

 

 

 

sweaty.

 

1.His vital signs were as follows:

 

Blood pressure (155/ 95 mmHg)

 - High (Stage 2)

Temperature (37°C)

 - Normal

Respiratory (30 breaths/ min)

 - High (12-16 Normal)

Pulse (110 beats/ min)

 - High

 

2.Oxygen saturation: 88% on room air (normal range: 95 

–100% on room air).

 - SpO2

3.Bilateral pitting oedema up to the knees was present.
- Pit formed after pressure
- Exudate
 4.The jugular venous pressure was raised at 7 cm. 
- Discuss LO nanti
5.The apex beat was at the 6th intercostal space at the mid

clavicular line.
- Heart hypertrophy
 6.There were crepitations heard over the posterior lung bases posteriorly.
-Pulmonary Oedema

INVESTIGATIONS
1. Blood test
2. ECG
3. Lipid Profile
4. Echocardiogram
5. Chest X-ray
6. Serum Electrolyte

 

3.left ventricular hypertrophy 

4. hypokinetic inferior segments.

 

5.The ejection fraction was 41%.
-low

 

 6.pulmonary oedema.

 

 7.congestive heart failure secondary to hypertension and previous myocardial infarction.

 

8. Treatment including oxygen

9. diuretics
- Reduce water and salt in body


10.nitrates

11.vasodilators

12.ACE inhibitors, and beta-blockers was administered. 

13. A fluid restriction of 1 liter a day was imposed 

14. Sodium level
-low due to excess of water.
-less concentration of sodium (diluted)

 

4. hypokinetic inferior segments.

 

5.The ejection fraction was 41%.

 

 6.pulmonary oedema.

 

 7.congestive heart failure secondary to hypertension and previous myocardial infarction.

 

8. Treatment including oxygen

9. diuretics

10.nitrates

11.vasodilators

12.ACE inhibitors, and beta-blockers was administered. 

13. A fluid restriction of 1 liter a day was imposed 

14. Sodium level