A 63 yr old male patient came with complaints of chest pain and SOB since 2 days

 A 63 year old male patient , resident of narketpally,labourer by occupation came with CHIEF COMPLAINTS: 

CHEST PAIN SINCE 2 DAYS

SHORTNESS OF BREATH SINCE 2 DAYS

HISTORY OF PRESENTING ILLNESS: Patient was apparently asymptomatic 2 days ago then he developed CHEST PAIN - Heaviness in the chest,insidious in onset,dull type of pain on exertion radiating to left hand and shoulder since 2 days

SHORTNESS OF BREATH was sudden,not progressive,grade 2(nyha), aggregating on exertion, relieving on resting since 2 days

H/o easy fatigability since 2 days

No h/o giddiness,nausea, vomiting , headache, sweating 

No h/o extertional dyspnea,orthopnea,paroxysomal nocturnal dyspnea, palpitations,postural hypotension

No h/o pedal edema

No h/o burning micturition , decreased urine output

No h/o blurring of vision,tingling sensation,numbness

PAST HISTORY: HYPERTENSIVE SINCE 6years on medication Amlodipine

Diabetic since 6years on medication Metformin

No h/o Asthma, epilepsy,thyroid disorders,TB

CAD,CVS

FAMILY HISTORY: NOT SIGNIFICANT

PERSONAL HISTORY: 

DIET-MIXED

APPETITE - NORMAL

SLEEP- ADEQUATE

BOWEL AND BLADDER MOVEMENTS: REGULAR

ADDICTIONS - NO

GENERAL EXAMINATION:

Patient is conscious , coherent, cooperative.Well oriented to time place person.Moderatley built, moderately nourished

PALLOR: Absent 

ICTERUS:Absent

CYANOSIS:Absent

CLUBBING:Absent

PEDAL EDEMA:Absent

LYMPHADENOPATHY :Absent

VITALS:

BP:120/80

PR:75bpm

CVS:S1S2 heard,no murmurs heard

RS:BAE+

JVP: SLIGHTLY ELEVATED

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM:

INSPECTION:

Apical impulse not visible

No precordial bulge

JVP - SLIGHTLY ELEVATED

PALPATION:

ALL INSPECTORY FINDINGS WERE CONFIRMED

Trachea : central

Apex beat : Medial to midclavicular line

No palpable murmurs

AUSCULTATION:

S1S2 Heard

No murmurs

INVESTIGATIONS:


PROVISIONAL DIAGNOSIS:

?RIGHT HEART FAILURE


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