A 45 year old male with chest pain

February 03, 2024

Patient came with chief complaints of chest pain 1 episode 6 days back

Patient was apparently alright 10 to 12 years when he developed increased drowsiness for which he consulted a doctor and was diagnosed to have hypothyroidism for which he used medication for 2 to 3 years and stopped it.he developed generalised body pains more on the neck and back insidious in onset, intermittent aggravated on working and relevied on taking rest. 

Then 1 week back after his dinner (non veg) he started feeling tightness in his chest(like acidity in patients words) and started feeling hot and his breath became heavy for which he tried to on the fan and became unconscious as he got up. The pain was localised non radiating. When he got unconscious his family members observed that he was profusely sweating and pass urine involuntarily following which his family members took him to the hospital for which treatment was done for coronary artery disease, acute inferior wall mi with EF 45%

He later got consciousness at approximately at 12 am to 1 am

No H/O nausea, vomiting, fever, cold, cough

No H/O weight loss

DAILY ROUTINE:-

Patient has no fixed daily routine 

He has been working as a cab driver for the past 25 to 30 years

Patient said that he has been working excessively with lack of sleep in the past 1 month

PAST HISTORY

Known case of hypertension since 2 years on regular medication

Known case of hypothyroidism 10 to 12 years back for which he used medication for 2 to 3 years and stopped

Known case of TB when the patient was 7 or 8 years old and took medication 

Not a known case of diabetes, epilepsy

PERSONAL HISTORY:-

Appetite: normal

Bowel and bladder movements: regular

Diet: mixed

Sleep: normal

Addictions: non alcoholic, smoker for 15 to 16 years 22 bidis every day stopped after the episode if chest pain

GENERAL EXAMINATION:-

Patient conscious coherent and cooperative 

Pallor absent

Icterus absent

Clubbing absent

Cyanosis absent

Lymphadenopathy absent

Pedal edema present pitting type 


EXOPHTHALMOS OBSERVED:-


SKIN CHANGES NOTED:-


TRUNK AND ARMS



LATERAL VIEW NECK FOR THYROID SWELLING





VITALS:-

BP 90/70 supine 80/60 standing

PR 84

GRBS 114

Temp afebrile 98.7


CVS EXAMINATION

Inspection:-

Chest wall is normal 

No scars, veins or sinuses

Apical impulse not seen

Palpation:-

No kyphoscoliosis

Apical impulse normal felt in 5th inter-coastal space later to the mid axillary line

No pulsations or thrills felt

Auscultation:-

S1, S2 heard no murmurs heard


RESPIRATORY SYSTEM:-

Bilateral air entry present

Non vesicular breath sounds heard


ABDOMEN:-

Soft, Non tender

No organomegaly felt


NERVOUS SYSTEM:-

No focal neurological deficits


INVESTIGATIONS:-

ECG ON 28/01/24


ECG ON 29/01/24


ECG ON 30/01/24


ECG ON 03/02/24

ECG ON 04/02/24

CHEST X RAY 04/02/24



CORONARY ANGIOGRAPHY DONE ON 30/01/24





TREATMENT GIVEN:-

Tab.Ecospirin 150mg OD 

Tab.Isosorbide mononitrate 10mg BD

Tab.Atorvastatin 40mg HS

Tab.Clopidogrel 75mg OD

Tab.Pantoprazole 40mg OD

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