36 year male ,chest pain since 2 months and history of Aortic valvotomy in 1997

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  A 36 yr old male with chest pain and history of valvotomy

C/O :chest pain since 2 months 

HISTORY OF PRESENTING ILLNESS 

-Patient was apparently asymptomatic 2 months back then he developed left sided chest pain , throbbing type , which was intermittent at beginning and became continuous since 1 month , pain is radiating to left shoulder and neck , pain is aggrevated by riding bike and on long sitting and relieved on lying down (supine Position ) for some time

-History of back pain due to fall in washroom 4-5 days back

 History of increased sweating since 2 months on continuous walk for 10 - 15 feet distance

 PAST HISTORY :

-K/C/O poliomyelitis

-K/C/O allergic asthma 8 years ago and used inhaler ( present not on any medication)

 -N/k/c/o DM , HTN , TB , epilepsy , thyroid

SURGICAL HISTORY : 

-

valvotomy in year 1997, right nasal polypectomy in year 2018

PERSONAL HISTORY: 

-Appetite normal , 

-mixed diet , 

-regular bowel movements , burning micturition, 

-sleep inadequate due to pain , -consumes alcohol occasionally since 4 years ,

- smoking since 4 years

 -No known food allergies , allergic to dust .

GENERAL EXAMINATION

 

Patient is conscious, coherent cooperative

No pallor , icterus , cyanosis , clubbing , generalized lymphadenopathy,pedal edema

CNS EXAMINATION-

             RIGHT. LEFT

TONE-

UL- 5/5. 5/5

LL- 4/5. 4/5

POWER:-

UL- 5/5. 5/5

LL- QUADRICEPS-2/5. 2/5

        HAMSTRINGS-2/5. 2/5

        GLUTEUS. - 3/5. 3/5

REFLEXES- 

BICEPS- 2+ 2+

TRICEPS. 2+ 2+

SUPINATOR. 2+ 2+

KNEE- BRISK. BRISK

ANKLE- BRISK. BRISK

PLANTAR- MUTE. MUTE

Investigations:

ECG:

2D echo: