dear sir,

A 69 year old chinese male from MUar, formerly working as a lorry driver was admitted 14 days ago with chief complaints of difficult in breathing while lying down for 14 days and swelling of his both leg for 11 days.

he is a diabetic patient for 8 years and hypertension for 20 years which are under medical control.

He used to smoke 30-40 cigarettes per day and was stopped 30 years ago, recently he started to smokes again in which he smokes 15-20 cigarettes per day.He was a social drinker.

on admission he was treated with oral medication and according to him, 'fluid drainage' was done through the his uereter( sir, wat is the procedure been done actually?)

on examination:

jvp is not raise

pulse are irregularly irregular, radio-femoral delay is present

no pedal edema

no AV fistula

cvs examination:

1. Apical impulse not palpable
 
2. s1,s2 heard, no added sound( rhythm is irregular)

(other examination was not done because we went for case discussion at ward 8.)

sir, based on the finding, can we have a diagnosis about the case? what are the other history and examination i must do to come to a diagnosis?( as a short case)