35 Year Old Male with Pedal Oedema and Shortness of Breath

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Here's a case that I have seen -

A 35 year old labourer, a father of two, presented to the OPD with the complaints of pedal oedema (upto the ankle) facial puffiness and abdominal discomfort since 3 days.

He was apparently assymptomatic 3 months back. Then he developed pedal oedema for the first time for which he visited the RMP who prescribed Torsemide. The oedema subsided after taking the medication. The patient got the confidence that it will decrease everytime after taking the medication so he continued consuming alcohol and taking that medicine everytime he got developed oedema (3-4 times according to the patient and more than that according to the attender)

The pedal oedema was bilateral, gradual in onset, non-progressive, pitting type, non-tender.

The pedal oedema was followed by facial puffiness.

He has H/O chest trauma on the right side of the chest 1 month back (He fell from the bike after consuming alcohol) after which he developed chest pain on the right side of the chest and palpitations on and off.

He last consumed alcohol 5 days ago after which he developed pedal oedema and facial puffiness again. He even developed abdominal discomfort and shortness of breath at rest. He visited the RMP again who advised him to go to Kamineni, Narketpally.

Past History -

Patient had a perianal abscess 5 years ago.

He had painful defecation associated with pain in the perianal region, foul smelling stools and pus discharge in stools. No H/O blood stained stools. The patient visited the RMP for this as well and it subsided with the medication given by the RMP. Patient developed similar complaints 3 days ago.

Not a known case of Diabetes Mellitus, Hypertension, Epilepsy, Asthma, Tuberculosis, CVA, CAD

Personal History -

Mixed diet

Normal appetite

Adequate sleep

Regualr Bowel and Bladder Movements

Regular intake of alcohol since the past 10 years and chewing on tobacco since the past 3 years.

The patient dropped out of school after finishing 9th standard due to financial troubles and started working at a tiles factory. The patient got married early at the age of 21 years. He started consuming alcohol 10 years ago at the age of 25 years due to peer pressure from his friends. He started by drinking 5ml of sara which gradually increased to 90ml of whiskey and then quarter bottle of whiskey everyday. The patient started chewing tobacco 3 years ago as he feels relieved on chewing tobacco after a tough day at work. He consumes 1-2 packets everyday.

The patient tried to stop consuming alcohol 1 month ago due to pedal oedema and maintained abstinence for 15-20 days by using some herbal medication but was unsuccessful.

The patient last consumed alcohol 5 days ago on Monday before he got hospitalized. He consumed 3 quarters of whiskey on Monday (As he was visiting his different groups of friends)