This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 



Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. 

Case presentation: 
This is a case of 66 year old male who came with chief c/o of pedal edema since  6 months and sob since 1 month. Pt was alright 6 months back then he had insidious onset of unilateral lt leg swelling till lower part of leg not associated with any shortness of breath,decreased urine output, facial puffiness and swelling decreased after taking medication. From 1 month pt had insidious onset of shortness of breath, it gradually progressed from sob on exertion to sob at rest. Pnd + . It was not associated  with orthopnea, pedal edema, abdominal distension, fever ,vomitings ,loose stools ,chest pain,  palpitations, cough , decreased urine output,  facial puffiness. 
 Not a k/ c/o  DM,HTN ,ASTHMA,  TB EPILEPSY,  CVD
h/ o neck biopsy done 3 years back as he developed hoarseness of voice for which neck biopsy was done and got treated for 2 months  and his voice was improved.
Investigations done are : 
Link of the 2d echo video is given below :
Treatment:
1. Tab lasix 40 mg po bd
2. Tab rampiril 1.25 mg po od
3. Tab ecospirin 150/20 mg po h/s
4. Tab clopitab 75 mg od h/s
5. Tab isosorbide dinitrate 2.5 mg po od
6. Tab pan 40 mg po od
7. Tab met xl 25 mg po od

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