CASE

A 65-year-old man, known case of hypertension, complains of shortness of breath for 15 days.
This difficulty of breathing aggravates when he lies down and even at night, he has to get up and
open the window for air. He has also noticed swelling of both feet and legs extending up to the
thighs. He states that for last few months he feels tiredness and fatigue even carrying out routine
household activities. There is a history of smoking for the last 25 years.

General physical examination

An obese, anxious looking man, well oriented in time and space
BP: 180/105mmHg
Pulse: 100/min, regular
R/R: 32 bpm
Temp: 98.6 F o
A localized depression results when pressure is applied over the ankle joint.

Systemic Examination:

Respiratory System:
Breath sounds are diminished bilaterally, and percussion note is stony dull over right lower zone.
X-Ray chest reveals bilateral perihilar haze and also a large defuse opacification at the base of
Rt lung.
Cardiovascular System:
Lt ventricular hypertrophy and sinus tachycardia have been observed on ECG.
Abdominal Examination:
Enlarged tender liver with a span of two fingers below the Rt costal margin is observed.
Treatment:
Casualty medical officer advises oxygen inhalation and Injection Furosemide 80 mg I/V stat.
After about 1 hour, patient’s condition improves with significant decrease in difficulty of
breathing and blood pressure reading comes down to 130/85 mmHg.
He is discharged from the hospital with following medications and advised to follow up after one
week.

Tab. Hydrochlorothiazide 12.5 mg 1 x OD

Tab. Enalapril 10 mg OD
Tab. Metoprolol 25 mg OD