a 70 year old male with corpulmonale secondary to COPD

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A 72 year old male handloom worker occupation, resident of village near choutuppal presented to casualty with 

Chief complaints of :

Bilateral lower limbs swelling since 1 to 2years (on and off) associated with SOB.

Patient was apparently alright 20 years back when one day he had sudden on set of chest pain left sided associated with sweating and palpitations then he went to local hospital and told he had an heart problem (?CAD) then was using regular medications.

Since 2 years patient developed bilateral pedal edema (on and off) initially till ankle then progresses till above knee since then he had bilateral lower limb pains, easily fatigued, SOB on execution. Since then he had his work and 1 year back he was devastated by his wife death due to acute coronary syndrome.

Occasionally patient is having cough with sputum as his smoking consumption is increased.

Now since 15-20 days patient have bilateral pedal edema above thighs a/w SOB at rest and generalised body pains.

No H/o giddiness and herbal medication.

Smoker since 50 years (10 to 15 beedis/day)

Occasional alcoholic since 40 years.

N/K/C/O DM

O/E 

Bilateral pedal edema + (above thighs)

CVS- S1 S2 + (raised jvp)

RS - bae + B/L IAA crepts

P/A - soft and nt

CNS - NAD

Drug History : 

T.aten 25 mg (since 20yrs)

T.isosorbide 10mg OD (since 20yrs)

D/D - ANASARCA 2 to 1) HFPEF 2 to CAD

                                       2) Hypoalbuminemia

Provisional Diagnosis- 

?corpulmonale 2 to ?copd

?HFPEF 2 to CAD old IWMI

INVESTIGATIONS