A 42 years old lady taking treatment in her town for giddiness and pain in epigastrium, vomiting, and pain in joints and weaknesses for more than 15days, but don't find any relief, she was on ppi, etoricoxib, paracetamol, B. Complex. Investigations in town on 27-7-17 Hb9.3gm, ESR 110mm, X-ray chest shows cardiomegaly. TLC 9500. On 5-8-17 came to me having severe pain on both sides of the lower chest, severe pain in right hypochondrium, epigastrium and left hypochondria, mild fever, restless and pain on respiration over sides of the chest and upper abdomen.
Reinvestigations are done, again tlc 10500, Hb9.3gm, ESR80mm, cardiomegaly, S1S2 clearly audible BP 120/80mmHg, No liver palpable no edema feet. She was put on ATT 5drugs (SM) +ceftrioxime 1GM bid + furosemide 20mg/day, she relieved distress in the abdomen but the pain is constant. What to do next? What can be the further treatment?
