A full medical history and examination was taken from this patient suffering from recurrent acute exacerbations of COPD and heart failure. This 79 year old female has suffered with what she describes as a bad chest for over ten years frequently experiencing dyspnoea and chest infections. She recalls suffering many exacerbations and put this down to experiencing asthma attacks. The patient admitted she had smoked 10 cigarettes a day for 64 years- a 32 pack year history. She was experiencing recurrent exacerbations of shortness of breath, unable to walk without fatigue and sputum production. My initial thoughts were that she did not seem to be able to breathe well at all. This was quite alarming to me however she told me that this was usual for her. I felt somewhat reassured but I noticed that it was difficult to make conversation with her properly because of the degree of dyspnoea. She was diagnosed with COPD in 2000 and put on an inhaled corticosteroid and bronchodilator along with oral steroids. Her exacerbations were attributed to chest infections and she was given antibiotics to combat them. However, as the exacerbations kept coming back, the cause could be something more than respiratory infection. A cardiac cause was suspected, and more precisely- congestive cardiac failure. She showed symptoms of right sided or biventricular failure as she has peripheral oedema and symptoms of left sided heart failure heart failure such as, shortness of breath together with a reduction in mobility and fatigue. She was diagnosed with cardiac failure. She was prescribed a diuretic- Frusemide, it is possible that pulmonary oedema could have been triggering the attacks. She has received stents for ischaemic heart disease. The patient describes symptoms of paroxysmal nocturnal dyspnoea - unable to sleep lying down and needing the aid of pillows to prop her up. She reports sleeping with three pillows but is still unable to sleep well. This was a...
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