Physician's Assistant

Patient Details

Sdec (283 days ago 11:20)

Sdec Fri 27 June 2025 11:20

Last Modified: 283 days ago

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Content:

Presenting Complaint:
Right leg DVT concerns

Past Medical History:
• Congestive cardiac failure

Diagnosis:
Peripheral oedema secondary to congestive cardiac failure

I had the pleasure of meeting Mr Trevathan in Same Day Emergency Care today.

Mr Trevathan attended with concerns of a right leg DVT, however this was excluded on ultrasonography. On examination he had pitting oedema to the hips bilaterally. Heart sounds demonstrated a soft systolic murmur. Chest auscultation was clear and recent chest X-ray showed no evidence of pulmonary oedema. He is currently using furosemide 40mg three times daily.

I discussed that his scan does not demonstrate any DVT and his leg swelling is most likely secondary to peripheral oedema secondary to CCF which he is already being treated for with furosemide. I have suggested switching his furosemide to bumetanide 2mg BD for improved absorption given likely gut oedema. Echocardiogram was considered however symptom guided treatment seems to be most appropriate in this case.

Investigations:
Ultrasound Doppler of right leg: Negative for DVT
Chest X-ray: No evidence of pulmonary oedema

Plan:
1. Switch furosemide to bumetanide 2mg BD
2. Check U&Es in 1 week to ensure no kidney injury on starting bumetanide
3. Continue current heart failure management

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Patient Details

Sdec Fri 27 June 2025 11:20

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