A 58 year old male, labourer by occupation, came to the OPD with the chief complaints of Shortness of breath since 30 days,which was worsened 1 day back(19/02/22), chest pain since 30 days ,facial puffiness since 30 days History of Presenting illness - Patient was apparently asymptomatic 3 years ago then developed giddiness, for which he went to a local hospital and was diagnosed as Hypertensive, for which he is taking T. Nicardia 10mg, T. Arkamine 0.1mg sos. Then 2 years back he developed B/L pedal edema, which progressed gradually to knees and diagnosed with renal failure, started dialysis weekly twice. Since 4 months he developed left upper limb swelling and swelling at chest region,both of which got progressed to current size. Back pain since 2 months, which got subsided on medication (T. Ultracet). 30 days back - he developed shortness of breath ,Grade II-III which progressed to Grade IV since 30 days associated with orthopnea . Whereas from 4 days he developed right u
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