For a 61-year-old diabetic, hypertensive, coronary artery disease patient with dilated cardiomyopathy (ejection fraction ~31%) and recent defaulted extrapulmonary tuberculosis who became hypotensive on day 2 requiring norepinephrine and dopamine, is the shock primarily cardiogenic or septic, what caused the sudden deterioration, should early dobutamine/milrinone or intra‑aortic balloon pump have been used, and are the urinary red‑blood‑cell casts due to cardiorenal syndrome or a tuberculosis‑related glomerulonephritis?

{
  "question": "Good morning sir\n**1.Case report**\nA [AGE]-year-old male who is a k/c/o T2DM/SHTN/CAD was brought with complaints of breathlessness, Bilateral swelling of legs, abdominal distension for about [DURATION]. On admission he was conscious, Oriented tachypneic with Bilateral creptitations all over lung fields. He had a history of EPTB for which he took ATT for [DURATION] and stopped on his own.\nHe was Provisionally diagnosed as \nVOLUME OVERLOAD STATE/CAD/DCM /HFREF[EF%]/EPTB DEFAULTER/T2DM /SHTN \n\n[DAY]-He developed hypotension and was started on norepinephrine and was escalated to dual ionotropes with dopamine \n\nHe was on ionotropes till his death on [DAY].\n\nEcg showed LBBB with low voltage complexes\n\nInvestigations revealed elevated total counts with elevated rft, elevated total bilirubin, elevated esr, positive crp. sputum reports were negative, urine hb was positive, urine rbc cast was positive\n\nHe was treated with higher antibiotics and supportive care\n\nEcho -DCM /EF [EF%]\n\n*Queries*\n1.Adherence to CAD drugs and diet -whether he adhered or not \n2.History of EPTB where and how was he diagnosed and why he defaulted\n3.Any evaluation done regarding etiology of DCM \n\n *QUESTIONS*\n1.cause of shock purely Cardiogenic or associated sepsis\n2.cause of sudden deterioration in [DAY] \n3.any association between EPTB and shock in this case\n4.Initial bp was [BP] mmhg -Any role of dobutamine or milrinone in this phase \n5.Use of IABP in this case -if possible then why and what is the timeline and prerequisites in this case\n6.Positive Rbc casts -was it cardiac or non cardiac cause \n7.was it a cardiorenal syndrome or any possibility of glomerulonephritis \n8.If possible of glomerulonephritis, then can EPTB history be attributed to this\nThank you sir\ncrisp discussion\n*Do not change the language of the question*"
}