A CASE OF ELDERLY MALE WITH COMORBIDITIES.pptx
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An elderly male presented with cough, breathlessness for 1 month, generalized itching, and swelling in the feet. He has a past medical history of hypertension for 25 years, COVID infection 8 months ago, and swelling in the feet for 6 months. His symptoms have worsened over the past month. Investigations showed elevated kidney function tests and signs of renal disease on ultrasound. Echocardiogram revealed coronary artery disease, reduced heart function, and pulmonary artery hypertension. Due to uncontrolled hypertension and aortic bruit, further testing found renal artery stenosis on the left side. The patient was diagnosed with skin dryness exacerbated by itching and referred for cardiac catheterization and potential stent placement in the left renal artery if kidney function
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A CASE OF ELDERLY MALE WITH COMORBIDITIES.pptx
- 1. A CASE OF ELDERLY MALE WITH COMORBIDITIES
- 2. PRESENTING COMPLAINT • Cough • Breathlessness 1month • Generalised pruritis • Pedal edema
- 3. PAST HISTORY • Systemic Hypertension - 25 years • Covid infection – June 2022 – 8 month • Bilateral pedal edema – 6 month • Worsening of symptoms – 1month
- 4. INVESTIGATED • Evaluated from local hospital • CBC – Normal • Uric acid – 7.8 • Serum creatinine – 1.72 • ESR - 88
- 5. GENERAL EXAMINATION • Patient was consious , oriented • Multiple recordings of high BP – 180/100mmHg • Otherwise, Vitals were stable • No pallor, icterus, clubbing, cyanosis, Lymphadenopathy • Bilateral pitting pedal edema (+) R>L • Right lobe of Thyroid gland enlarged • Scoliosis with convexity to left
- 6. SYSTEM EXAMINATION • Tracheal shift to right • Bilateral rhonchi • Liver palpable 5cm below the right costal margin • Splenic tip palpable • Aortic bruit heard
- 7. INVESTIGATION • LIPID PROFILE • Elevated total cholesterol • Elevated LDH • LFT – unconjugated hyperbilirubinemia • Serum creatinine – 2mg/dL (rising from 1.76 from latest) • Thyroid profile – normal • Serum Vitamin D – 10.77 • HbA1c- 6.6
- 8. • USG neck – MNG with TR2 and TR1 nodules and features of thyroiditis. • USG Abdomen – s/o renal disease with grade II parenchymal changes, cortical echoes and prostatomegaly. • ECHO – CAD, RWMA, mild to moderate MR, moderate LV dysfunction, severe PAH.
- 9. • In view of uncontrolled hypertension and aortic bruit, renal artery doppler was done which showed renal artery stenosis on the left side. • He was seen by the Dermatologist for the generalised pruritus and was diagnosed to have Xerosis with eczematisation • He was seen by the Cardiologist and advised for • CAG Renal angio PTA + Stent to Left renal artery ( if residual renal function is normal.