45 year old male patient
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Here is a case i have seen:
Patient came to hospital with chief complaints of
giddiness ,heaviness in the chest
increasd on bending forward,lfting weights,SOB2/3,palpitations on activity,decreased stream of urine flow with decreasd urine output
C/o dry cough since 3 days .
no orthopnea,PND,chest pain
no h/0 pedal edema,facial puffiness.
patient was apparently asymptomatic 6 years back that is in 2014 after which he met with an accident .pt explains the incident saying that the person who is driving vehicle had taken alcohol but he didnt and he was siting on back of the vehicle ,he had left ankle injury at that time And it took 14 months for him for recovery,he doesn’t know what type of surgery done at left ankle and he complains pain at left ankle when he walks for long distance.
in 2016 when he went to vegetable market carrying wt of 15 kgs he felt weakness in his left arm he droped the 15kg bag and went to local RMP were high BP was recorded as 200/120 local RMP treated with antihypertensives then he went back to home after an hr as he felt relieved.
After 3 months in 2016 he was riding a cycle he felt weakness in both left UL and LL and he was unable to do pedaling of his cycle and experienced profused sweating he took an auto and went home, he took a wet cloth and wiped his body to relieve sweating and he says that symptoms were relieved within 3 hrs (?TIA).As he worried about his health he went to Dr. after two episodes of stroke ,MRI was taken which was normal and at that time he had bp 150/90 so he advised to take tab amlodipine 5mg OD and tab lasartan 50mgOD and tab pantop 40 mg OD ,Tab aspirin 75 mg,Tab atova10mg, he used to go regular follow up till 2019,
in 2017 he had abdominal discomfort and used to pass stools 2-3 time / day which were watery in consitency and he says frequency of stool was more during night time involuntarily unkowing to him he passed stools on bed not associated with any pain abd ,tenesmus nd no h/o incomplte defecation
n/h/o mucous ,blood in stools,n/h/o malena,he took regular medication(unknown) (2017-2020 till august)for in voluntary defecation
in nov 2020 he had chest pain on exertion ,dyspnoea on exertion.
Not a known case of hypertension ,diabetes,epilepsy ,TB or asthma
General examination ;
Patient is conscious,coherent,cooperative moderately built and nourished Pt wt= 83kgs
Height =5.7 inches (170.18 cm)
No pallor icterus clubbing ,cyanosis, lymphadenopathy ,EDEMA + in B/L
Vitals:patient is afebrile
Bp:130/90mmhg
PR:100bpm
Cvs:s1,s2+,no murmur ,jvp normal,no pedal edema.
RS:BAE+ No added sounds
GRBS:106mg/dl
Patient is a farmer by occupation and is a chronic smoker with smoking history of 1 pack per day for 20 years .But he stopped to smoke recently since 1 year .
He is even a chronic alcoholic since 20 years .
Appetite normal ,bowel and bladder movements normal ,adequate sleep
Day 1
6min walk test
Expected (in metres)=414 cm
Distance walked =330m
Spo2 at start =99%@RA
After 6 min =98%@RA
=58% of normal (taking upper reference value )
(Ul=567.26m
L.L = 414m)
ECG on 3/12/2020
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