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20 years old female with SOB and chest pain


20 year old female with SOB and chest pain

A 20year old female presented to the hospital with the chief complaints of sob since 7pm yesterday and chest pain since 6pm 











History of present illnes:






Pt was apparently assymptomatic 2yrs back then she noticed hair fall for which she consulted to doctor. Upon performing the tests she was diagnosed with Hyperthyroidism for which she was given medication - Carbimazole (20mg) (OD).

 

One year later patient developed chest pain of crushing type and non radiating which was insidious in onset and continuously present with mild grade and was using pain killer for the same.

- She experienced one episode of SOB which was relieved after some time.

- In Jan 2021 she was attacked with COVID and recovered .

- In Jan 2022 she was again attacked with COVID and recovered.

- In Feb 2022 she had episode of acute chest pain and was diagnosed with Mitral valve prolapse.

Pasr history: 

- History of hyperthyroidism since 2 years.

- No H/O TB,  Asthma, Diabetes, HTN, CAD

Family History: 

H/O thyroid disorder(hyperthyroidism)2 in her Grandmother.

Personal History:

Sleep: adequate

Diet : mixed

B&B : Regular

Addictions: No

Allergy: No

General Examination:

 Patient was examined in a well lit room after a informed consent. Pt was moderately built and nourished. Pt was conscious, coherent and cooperative well oriented to time space and person.

Pallor, icterus, clubbing, cyanosis, lymphedenopathy, edema- not present.

Vitals:

Temp: 98°F

Pulse rate: 113 / min

RR: 21 cpm

BP: 160/110 mm/Hg

SpO2 : 98%







Respiratory system:

Inspection:

No tracheal deviation 

Chest bilaterally symmetrical

Type of respiration: abdomino thoracic.

No dilated veins,pulsations,scars, sinuses.

No drooping of shoulder.

Palpation:

Inspectory findings are confirmed.

No local rise in temp. and tenderness.

Expansion of chest equal and symmetrical in both sides.

Auscultation:

Normal vesicular breath sounds are heard.

No crackles, wheeze or plueral rub.

CVS Examination:

JVP normal, apex best heard at the 5 th intercostal space medial to mid clavicular line

S1 S2 heard, No murmurs/thrills heard

Per abdomen:

Soft and non tender

Bowel sounds are heard

CNS: 

Higher motor functions are normal

No focal deficits.

Provisinal diagnosis:

Mitral valve prolapse, No mitral regurgitation with normal biventricular systolic function.

Investigations:















Treatment: 

1. Inj. Pantop 40 mg iv bd

2. Tab. Carbimazole 20mg bd

3. Syrup. Sucralfate 10md tid



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