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A 55 Yr old man presented with shortness of breath 20 days and swelling of both lower limbs since 10 days

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  This is online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs .This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome A 55 Yr old male presented with shortness of breath 20 days back and swelling of both lower limbs since 10 days History of presenting illness : Patient was apparently asymptomatic 2 years back then he developed Shortness of breath while lifting weights  then 20days back started to develop SOB even while doing normal work and occasionally it used to present while taking rest or on lying down , walking  and relieved to some extent in sitting position.  Patient also complains of Pedal