c/o breathlessness along with difficulties in breathing associated with ckd and decreased ejection  fraction of heart since 2016. He is on regular medication of carca 6.25mg NTGN 2.6mg, torget plus 10mg, Rosuvas 10mg and dapone 10mg. patient has h/o covid 19 infection in 2021 and has been recovered from the same. But since then he started with raised creatinine level, Htn and decreased ejection fraction of L VE by 40% c/o pedal oedema on/off.