Case Study - Respi/Cardio - 27072016Created by:
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 ??