67 year old man with dyspnea on exertion since 3 months

Unit 3: 
Interns:
Dr. Kalyan
Dr. Sreeja
Dr. Archana
Dr.Harsha
Dr. Jeeharika

Dr. Raveen 
Dr. Aashita 
Dr. Vamshi 
Dr. Aravind 
Dr. Manasa ICU PG
Dr. Hareen SR
Dr. Praveen Naik - Ass. Prof

67 year old man presented with the complaints of
Dyspnea on exertion since 3 months
Giddiness on and off since 1 month
Patient works as a farmer at a local village. He is a father of 2 children.
He has consumed alcohol mainly whiskey everyday the last 35 years. Since 1/2 an year, he has been only drinking whiskey on rare occasions.
He also has been a cigarette Smoker for the last 35 years with around 20 cigarettes per day. He stopped smoking half year ago.
On routine checkup, he was told to be a diabetic 18 years back and also was told to be a hypertensive 2 years back. Since then he has been using medications religiously.
2 years back, he started noticing blood in his stools on and off for which he visited our hospital, KIMS. He was diagnosed with anemia back then and also received 2 blood transfusions.
1 year back, he had a dental appointment for which he consulted medicine for fitness. He was then told to have low hemoglobin along with a heart problem. He was suggested to visit a cardiologist.
The cardiologist told that he had a heart attack previously. He was precribed certain medications which he has been using since then.
The attendant also tells that he had pulmonary kochs 30 years back for which he used ATT.
He is an obese man
With pallor
His heart beats at 80 bpm with a blood pressure of 130/80mmhg
His respiratory rate is 20cpm
He is Afebrile to touch 
Sats is 97% on room air
Grbs was 170mg/dl
Cvs -
Could not assess his apex beat
Muffled S1, S2+
Lungs - Expiratory wheeze in all the lung fields
Per Abdomen - Non tender
Bowel sounds +
- Heart failure with reduced EF (25%) 
- Acute exacerbation of COPD
- Anemia under evaluation 
- K/C/O Hypertension and type 2 DM.

ECG -
CHEST XRAY-
2D ECHO-
HEMOGRAM-
CUE-
LFT-
RFT-
LIPID PROFILE-
T3 ,T4 TSH-
GLYCATED Hb-6.9%
FBS-132 mg/dl
ESR-25mm/1st hour
CRP- NEGATIVE
RAPID HBSAG- NEGATIVE
RAPID HIV -NON REACTIVE
USG ABDOMEN -

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