55y female with chest pain

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Patient was brought to causuality at 1am with c/o chest pain since 2 hrs,pricking type ,continuous.  Non radiating associated with pain in epigastrium .

 No sob,cough ,palpitations ,seatings, giddiness.

Pt complained of b/l leg swelling and multiple joint pains bilaterally symmetrical for both UL and LL since 5months back and c/o early morning stiffness and Restriction of movements associated with neck pain and jaw pains went to hospital in nalgonda where they said there was sugars in blood and urine. Then she felt better with his medicine.

K/C/O HTN ,DM2 SINCE 2 MONTHS ( TREATMENT UN KNOWN )

GENERAL EXAMINATION-

gait

joint stiffness

reflexes,1,2

PT IS C/C/C

TEMP-AFEBRILE

PR-88BPM

RR-16CPM

BP-120/100MMHG

SPO2-98%

CVS-S1S2 HEARD,NO MURMURS

RESP-BREATH SOUNDS EQUAL ON BOTH SIDES

P/A-SOFT,NON TENDER.

CNS-NAD

INVESTIGATIONS:

2DECHO-NO AR/MR/TR

NO RWMA,NO AS/MS,SCLEROTIC AV

GOOD LV SYSTOLIC FUNCTION

     Ultrasound abdomen:

ULTRASOUND -BILATERAL GRADE 1 RPD

DIAGNOSIS:

-CHEST PAIN UNDER EVALUATION

-POLYARTRITIS (?RHEUMATOID ARTRITIS , B/L SYMMETRICAL INVOLVEMENT OF BOTH UL AND LL WITH CERVICAL ATLANTO-AXIAL AND TEMPOROMAMDIBULAR INVOLVEMENT)