https://padlet.com/hanifatiyah/Yr1postgrad Made with big dreams en-us 2017-07-24 04:49:44 UTC 2017-07-24 05:33:59 UTC hello@padlet.com https://padlet-assets.s3.amazonaws.com/icons/Dartstarget.png hanifatiyah https://padlet.com/hanifatiyah/Yr1postgrad/wish/179294284
Heng is a lorry driver aged 68 years and is new to your practice. He describes progressive dyspnoea that he has had for the past three months and is now breathless when showering and dressing. For the past week he has felt more comfortable overnight sleeping on three pillows.

Heng says he had a heart attack 15 years ago, which was treated with a stent, and has had no chest pain since then. He has had problems with high blood pressure and cholesterol. His medications are 

1. T. Aspirin 100 mg od, 
2. T. perindopril 5 mg od
3. T. atenolol 50 mg and  
4. T. atorvastatin 40 mg od.

Ha is married and has two children. He stopped smoking when he had his heart attack and drinks a small amount of alcohol.

On examination his heart rate (HR) is 90 bpm and regular, and blood pressure (BP) is 150/90 mmHg. Jugular venous pressure (JVP) is difficult to measure but you think it is slightly elevated. There is a soft systolic murmur at the apex. The chest is clear. He has mild bipedal pitting oedema.

What is your provisional diagnosis? What initial investigations will you order? What initial therapy will you start?]]> 2017-07-24 05:08:42 UTC https://padlet.com/hanifatiyah/Yr1postgrad/wish/179294284