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-
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)
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