Case study: Mr Harinder Kumar Mr Harinder Kumar is a 60-year-old man referred by his GP to the cardiology clinic. Mr Kumar has known severe left ventricular systolic impairment secondary to Ischaemic heart disease with extensive peripheral oedema diagnosed as decompensated heart failure. His past medical history includes diabetes type 2 treated with insulin, and he has diabetic peripheral neuropathy. On examination, Mr Kumar was generally well, with no shortness of breath at rest, orthopnoea, chest pain, palpitations, or syncope. Mr Kumar works as a taxi driver and has limited physical activity, recently, he has been trying to walk at least 30 minutes each day but reports feeling fatigued and breathless with his ordinary physical activity. His vital signs were within the normal range: BP sitting 122/58mmHg and standing 112/55mmHg, HR 70bpm, Spo2 97% on RA, temperature 36.2oC. Mr Kumar's GP noted a significant increase in his weight from 75kg two months ago compared to his current weight of 87kg. Past Medical History [PMHx]: - Severe left ventricular systolic impairment - Ischaemic heart disease - T2DM - Peripheral Neuropathy Current medications include: - bumetanide 1mgtwice daily - spironolactone 25mg once daily - aspirin 75mg once daily - metformin 1g twice daily - NovoMix® 30 - ramipril 5mg twice daily - simvastatin 40mg once daily - bisoprolol 3.75mg once daily and - Bendroflumethiazide 5mg twice weekly.
Task 1: Review and synthesise the case scenario
Define the patient's current medical condition/disease (you may use ISBAR or the clinical reasoning cycle to help you organise your thoughts). Key points to cover as part of this review will be to:
1. Explain the pathophysiology of the disease.
2. Discuss how the current presentation relates to the patient's past medical history?