51 YEARS OLD FEMALE WITH LEFT SIDED CHEST PAIN

Unit posting (Intern 2017)

Medical Ward

GM II

Dr Nikitha

Dr Hari Priya

Dr Govardini

Dr Sneha

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Patient came with chief complaints of left sided chest pain since 10 days

DAILY ROUTINE:

- Patient typically wakes up at around 6:30/7 and starts the day by eating breakfast which usually consists of half a plate of rice accompanied by some curry and a glass of water, doesn’t really consume tea or coffee, and sits down with her family consisting of her husband, her adolescent daughter and her adult married son along with his wife.

- She is an agricultural worker by occupation and goes to the fields at around 8:30-9 by catching an auto about 15 minutes away from her home.

- Works till lunch which is around 12pm, and she usually packs her own lunch and eats in the fields itself with her co-workers. Her diet namely consists of large amounts of rice consumption along with loads of vegetarian curry such as green leafy vegetables typically, and occasionally going for non veg dishes usually with toddy (consuming about 200-350ml) , namely during functions.

- During her work, she doesn’t do much heavy lifting, just typically ploughs and looks after the fields, watering them right and planting new ones.

- She finishes her work at around 5 and heads home, washes up and sits down with her family for dinner. Watches television to end the day and goes to bed at around 8-9 pm regularly. She hasn’t complained of any sleep disturbances due to her complaint as to why she visited the hospital.

HISTORY OF PRESENTING ILLNESS :

- Patient was apparently asymptomatic 10 days ago when she developed upper left sided chest pain, dull aching type which was insidious in onset, gradually progressing, and

- since 1 day, the pain exacerbated by radiating posteriorly of the same side ie upper left side of the chest that was sudden in onset, with slight progression upto the elbow which was insidious in onset.

- Partially relieved on massaging balms over the area. No aggravating factors as such.

- h/o bloating since 3-4 months, insidious in onset, intermittent in nature.

- Associated with generalized weakness

- no h/o sudden heavy lifting of objects, sweating, fever, shortness of breath, Postural nocturnal dyspnoea, cough, palpitations, abdominal pain.

- no h/o any change in pain on food consumption, constipation, diarrhea

PAST HISTORY:

- no h/o similar complaints in the past

- h/o hysterectomy 5 years ago

- no h/o DM, HTN, TB, Epilepsy, CVA, CAD.

GENERAL PHYSICAL EXAMINATION:

No s/o Pallor, icterus, clubbing, cyanosis, lymphadenopathy, edema.