50yrs old man with breathlessness and chest pain since 1yr

Name-xxx
Age/sex- 50/male
Occupation- farming
Add- ...xxxx
Religion- Hindu

Present complain- difficulty in breathing since 1yrs .cough with expectoration since 1 month..fever occasionally in 2-3 months recurrently..
Breathlessness during walking and dust...
Family /history __
Mother was suffering from breathlessness hypertension...

Tongue- white coated
Gait-mild shifting to left side during walking
Skin-normal...
Apetetite- normal..
Thrist- normal 3lit in a day
Motion _ no complaint
Urine- normal...quantity and colour...
No smoke
No liquor
BP- 118/75mg/hg
Pulse- 74/min
RR- 21/min
Tobacco_ stop 7month back


Past complain- difficulty in breathing(short breath) since birth ..complains are aggravated in the works of farming mostly ..dusty works(Bhusa storing) ..patient take Treatment occasionally when complain is severe and got relief by mdcn ..breathlessness on walking ..fatigue on least exertion ..patient aversion to walk Bcozz of breathlessness ..

Examination __ B/L creps
Systemic examination_ systolic murmur (+) over apical area not radiating.

Investigation- CBC
                   CXR ..PA
               ECG
            RBS
          LFT/RFT
         RCHO
Echo findings- MVP with severe MR
- Normal LV.  EF
- No intra ventricular septal defect
- Mild TK
- No regional wall motion abnormalities..

Treatment - Tab. Lasix
             Tab. Aciloc 150
         Tab. Deriphylin..