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What causes severe productive cough, breathlessness and swollen ankle with history of CHF?

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Posted on Thu, 12 May 2016
Question: My uncle who is 93 was diagnosed with congestive heart failure approximately 5 years ago. During the last week and a half, he's been experiencing more than normal ankle and feet swelling, he has been coughing severely and coughing up brown to yellowish mucus. He coughs so hard that his breathing is affected. He's unable to lie down because he can't breathe and then he panics. His current doctor has never really treated his CHF - he's on no specific medicine for this condition. Should he not be on some kind of medication to help with this problem?
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Answered by Dr. Prabhakar C Koregol (15 minutes later)
Brief Answer:
yes he has to be on medicines and on urgent basis

Detailed Answer:
Looking at the way you have described the symptoms and clinical picture I understand he is in very advances stage of heart failure. I am surprised to know he is not on any medicines. He will need medicines on urgent basis and there could be indication for hospitalisation as well.
When we treat CHF of this nature there will two concerns and two pronged approach. First is to identify the cause for acute precipitation in his case it looks like respiratory infection although other issues like arrythmia can not be ruled out. He would need antibiotics, nature of which will be decided by further evluation such as blood count, sr creatinine and chest x ray.
Also as definative treatment he would need ACE inhibitors, beta blockers, diuretics, aldosterone antagonists and may be digoxin, antiplatelets and statins. But with information available I will not be able to suggest molecule and dose to be taken.
he also needs some work up like ECG, Echo, Pro BNP levels, Cornoary angiogram, liver function test, Renal function test, Pulmonary function test and any other test that may be dictated by above tests.
Since its complex issue you should immediately get in touch with cardiologist.
He may additionally require oxygen and IV Diuretics for stabilisation
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Prabhakar C Koregol

Cardiologist, Interventional

Practicing since :1998

Answered : 427 Questions

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What causes severe productive cough, breathlessness and swollen ankle with history of CHF?

Brief Answer: yes he has to be on medicines and on urgent basis Detailed Answer: Looking at the way you have described the symptoms and clinical picture I understand he is in very advances stage of heart failure. I am surprised to know he is not on any medicines. He will need medicines on urgent basis and there could be indication for hospitalisation as well. When we treat CHF of this nature there will two concerns and two pronged approach. First is to identify the cause for acute precipitation in his case it looks like respiratory infection although other issues like arrythmia can not be ruled out. He would need antibiotics, nature of which will be decided by further evluation such as blood count, sr creatinine and chest x ray. Also as definative treatment he would need ACE inhibitors, beta blockers, diuretics, aldosterone antagonists and may be digoxin, antiplatelets and statins. But with information available I will not be able to suggest molecule and dose to be taken. he also needs some work up like ECG, Echo, Pro BNP levels, Cornoary angiogram, liver function test, Renal function test, Pulmonary function test and any other test that may be dictated by above tests. Since its complex issue you should immediately get in touch with cardiologist. He may additionally require oxygen and IV Diuretics for stabilisation