Case Study - Respi/Cardio - 27072016

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27 Jul 2016 - General

86 y/o gentleman, with recent Ischaemic Heart Disease (Non-ST elevation mycordial infarction 3 months ago, medical management), hypertension, type 2 diabetes mellitus, and previous stroke 6 years ago, was admitted due to increasing dyspnoea for the last 2 days, with significantly reduce exercise tolerance, and increased bilateral ankle swelling. No chest pain, no productive cough, no feverish symptoms, and no urinary symptoms. Oxygen saturation was 85% on room air, examnitaion showed elevated JVP, bi-lateral pitting odema, and auscultation of chest showed bi-lateral fine crackles, with reduced air entry bilaterally. ABG showed type 1 respiratory failure, and chest x ray showed pulmonary oedema. Normal WCC, neutropil , CRP, slightly elevated troponin, pro BNP 1400, ECG sinus tachycardia 110. What will your diagnosis, and managemen plan for this patient ?? 

Yes, patient had flash pulmonary oedema, / congestive cardiac failure, which is likely due to his recent ischemic heart disease (NSTEMI). Bedside ECHO showed that he has low ejection fraction of around 30%, with apical akinesis. He was given high dose intravenous frusemide for diuresis, and urinary catheter was inserted to monitor urine output. Patient’s oxygen level was still low despite given 100% oxygen. Hence, he was given non-invasive ventilation (NIV), which was CPAP (Continuous positive...
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