A 75 year old male with peripheral vascular disease of left lower limb with supraventricular tachycardia

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is a case i have seen:

 A 75 year old male,farmer by occupation,from miryalgudem.

c/o blackish discoloration of left foot since 2 months

gangrene of left lower limb ,extended from toes to calf muscles from past 2 months

He was  apparently alright 9 months back ,had a prick injury to sole,he went to local hospital to  rmp and took some medication,and there relieved with in 10 days .he is able to do normal work sonce then again ,from 45 days he had  having small wound and complaining of pain at wound site and went to local hospital and taje some medication ,non relieved and went to local orthopaedics doctor for further evaluation and investigated and  planned for 2 toes amputation and amputation done (2nd and 4th toe) and again not relieved and a belb jas been with pus has been ruptured spontaneously with foul smelling 1 week back .then he came to kamineni for further evaluation .Here diagnosed as left lower limb cellulitis ,around 10:00 pm ,he is having an episode of tachycardia with pulse rate @ 170 to 180 bpm ,diagnosed as SVT, for which ADENOSINE 6mg IV  has been given along with vagal maneuver and his pulse rate came back to normal and then for surgery has been posted left lower limb BELOW KNEE AMPUTATION done on 09 jan 21 .there are no significant post op complications .

he had an episode of SVT on POD 1 case has been seen and 2d echo was done which shown no significant motion wall abnormality. with vagal maneuver pulse rate returned to normal

on pod 2 again , a episode of SVT has been seen again  reduced with vagal maneuver and DILTIAZEM 90 mg SR has been advised

On pod 4 again hos Pulse rate recorded again @170 bpm with vagal maneuver came to 38 and to normal  ,again he was started on DILTIAZEM 30 mg TID

No history of fever,cold ,cough

no h/o chest pain,palpitation,syncopal attack

no h/o abdominal pain and distention,loose stools and burning micturation

he passed stools yesterday

no h/o nausea ,vomiting

h/o smoking since 40 years ,chutta and beedi  18 to 20 /day

h/o alcohol since 40 years daily , 90ml/day

no pallor,icterus,cyanosis,clubbing,lymphadenopathy, right side  pedal edema

left below knee amputation done and dressing intact 

no h/o Dm,HTN,TB ,asthma,epilepsy

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