Case Study - MA

MA is a 66 years Malay male who presented with a chief complaint of effort dyspnea for the last 2 weeks. He noticed that over the last 2 weeks, he was gradually getting more dyspnea on his morning walks and daily chores. For two days before seeing me, he was coughing at night on lying down. He is a known diabetic for the last 10years, and hypertensive for the last 3 years. 1 year ago, he had a minor surgical procedure in another private hospital for a complain of "dizzy spell". PE revealed a rather tachypneic 66yr male. His BP 160/95 with HR 90/min. There was evidence of cardiomegaly. He had a third heart sound and no significant murmurs. There were bilateral basal crepitations. There were no other significant clinical signs.

1. What is your working diagnosis?

2. What initial investigations would you order ?

3. How would you manage this patient ?

4. What minor procedure was done 1 year ago?

5. What ECG abnormality is shown on the ECG?