48-year-old gentleman with Grade IV SOB

A 48 year-old man came to the hospital with complaints of :

- Pedal edema since 1 month.

- Shortness of breath which aggravated since 2 hours. 

- Productive cough since 2-3 days. 

History of present illness :

The patient was apparently asymptomatic 1 month ago when he noticed swelling in both his legs which was gradually progressive, extending to his knees. 

H/o increased shortness of breath since 1 day which aggravated to Grade 4 SOB since 2 hours, a/w orthopnea and PND. 

H/o Productive cough since 2-3 days. 

No H/o decreased urine output. 

No H/o facial puffiness. 

No h/o fever, cold. 

Past history :

He is not a k/c/o DM, HTN, TB, BA, EPILEPSY, CVD.

Personal history :

Diet- mixed, Appetite and Sleep - Decreased, Bowel movements - Regular.

He smokes 3-4 cigarettes a day since the past 10 years. 

He costumes alcohol occasionally. 

Family history :

Not significant 

General examination:

Patient consious, coherent, cooperative.

Bilateral, pitting type of pedal edema present. 

No signs of Pallor, icterus, clubbing, cyanosis lymphadenopathy. 

Vitals: 

Temp: 97.3 F

Bp: 170/120 mm Hg

Pr: 126 bpm

Rr: 34 cpm

Grbs: 206 mg/dl

SpO2 at room air : 83%

Systematic examination:

CVS: S1 and S2 heard

RS: BAE +, ISA and IAA inspiratory crepts +, B/L ISA Wheeze +

P/A: soft , non tender

CNS: NAD

Clinical images :

B/L pitting edema 

Diagnosis :

? EXACERBATION OF COPD

? HEART FAILURE 

? COMMUNITY AQUIRED PNEUMONIA

B/L MILD PLEURAL EFFUSION 

Treatment :

INJ. LASIX 80 mg IV stat

Nebulization