A 45YRS OLD FEMALE PATIENT WITH PALPITATIONS, PEDAL EDEMA, RADIATING PAIN ALONG LEFT UPPER LIMB

 G.Rohith reddy


Roll no:159


Case discussion:


A 45 years old female ,house wife by occupation came to opd with chief complaints of palpitations,chest heaviness,pedal edema,chest pain,radiating pain along her left upper limb , generalized body weakness


Cheif complaints:


*She complains that she could feel her own heartbeat since 5 days and it is more rapid since yesterday night.


*Pain along her left upper limb associated with tingling and numbness-6 days


*Chestpain -since5 days


*Difficulty in breathing-5 days


*Swelling over the legs(bilateral)-8 months


History of presenting illness: patient was apparently normal 8months back then she developed bilateral pedal edema which is gradually progressing and it is present both in sitting and standing position and relieved on taking medication.


Palpitations: since 5days which are sudden in onset,more during night time and aggregated by lifting weights, speaking continuously and it is relieved by drinking more water, medication


*dyspnoea during palpitations (NYHA-CLASS-3)-since5 days


*Pain:since 6days radiating along the left upper limb which is dragging in nature, aggrevated during palpitations and relieved by taking medication for palpitations.


*Chest pain associated with chest heaviness


Negative history: No-fever, vomiting, diarrhoea,muscle pain


Trauma history:Absent


Past history:blood infection -7 months back


Past reports:





*(right and left)paresis due to hypokalemia 1year back


2 months back came to KIMS NARKETPALLY for treatment of neck pain for which she received medication:







10 yrs back had the episode of paralysis of both upper and lowerlimbs(rt and left)


Not a k/c/o-(diabetes , hypertension,asthma,TB, epilepsy)




Drug history:notsignificant; 


family history:not significant


surgical history:not significant


Personal history:


Diet : mixed


;Appetite:normal;


Bowel movements-irregular


; bladder movements-normal;


Sleep: Inadequate (due to palpitations, dyspnoea,chest heaviness)


Addictions:no addiction


PHYSICAL EXAMINATION:

Patient is conscious coherent and cooperative

Well oriented to time place and person


Moderately built and moderately nourished 

Vitals:

Temperature: Afebrile


Pulse rate:78bpm


Bp:130/80mmHg


No-(pallor,icterus, clubbing, cyanosis, generalisedlymphadenopathy)


Edema:pedal edema(pitting type)




Systemic examination



RESPIRATORY SYSTEM : Normal Vesicular Breath Sounds Audible,B/l air entry present

CVS : S1 and S2 Heard,no murmurs

PA : Soft, No Tenderness, No Hepatomegaly or Splenomegaly

CNS : Intact

Investigations:CBP,CUE, 2D ECHO CREATININE,RFT,CHEST -XRAY


CBP:





CUE:





COLOUR DOPPLER-2DECHO


creatinine

RFT


CHEST X RAY(DONE ON 14-3-21) done for neck pain.





Ecg:


Present treatment history:

Hospital 1:14/5/21

TabLassix-40mg(PO-OD)

TabMVT((PO-OD)

TabShelcal(PO-OD)

Hospital 2:(15/5/21)due to severity of palpitations,chestpain went to hospital2

Tab Flupertin :PO(BD)

Cap Clobitab:PO(OD)

Cap Azithromycin:PO(OD)

Tab Dexamethasone:PO(TID)



Diagnosis: cervical spondylosis

Recurrent hypokalemic paralysis



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