A 57 yr old female with c/o bloatedness, chest tightness and HTN
NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.
PATIENT HISTORY: Pt. is a 57 yrs old female. She was a singing teacher, by profession.
Till the age of 57 yrs, she was completely fine. Would prefer walking rather than using transport for short distances. Lead an active lifestyle and did a lot of tuition.
18-20 yrs ago, she participated in a walking competition. 2-3 days later, she c/o of dizziness, blurred vision, and almost fainted. She was rushed to the doctor who diagnosed her BP as very high. No medicine was prescribed.
In 2007 i.e 1-2 yrs later, she started c/o pain in the upper rt abdomen. The pain would be sudden and not very intense and also tender on touch. One wk later taken to Dr.who diagnosed it to be cholelithiasis and laparoscopic cholecystectomy was done the next wk. She was alright for 1 month.
After 1 month, she started c/o diarrhea with a lot of mucus and postprandial bloating. She would rush to the washroom 10 mins after a meal and often accompanied with diffused slight abd pain which would persist even after defaecation. Fecal quantity would be very low in vol. and would pass stool 3-4/day sometimes 6-7 times also and would c/o incomplete bowel movement. These symptoms still persist and no treatment is done for them.
For the past 7-8 yrs, sometimes at night, there is muscle cramps in both upper and lower limbs. On doing massage pain reduces. Difficulty in standing from a sitting position or vice versa, feels weak to get up.
In 2012, she started c/o dizziness and blurry vision and went to a pharmacy. Her BP was found to be high and given medicine by the pharmacy.
In 2017, one day she started c/o feeling fatigued, weak, and uneasy. Her TSH lvl was found to be high and hypothyroidism was detected. Using levothyroxine for the same. Her cholesterol was also high, taking medicine for the same. USG was also done which revealed hepatomegaly with moderate fatty infiltration.
2-3 yrs ago, one day she started c/o lightheadedness and palpitation. She also vomited. She was taken to the hospital and her BP was found to be high (pt cannot recall what can be the etiology; maybe she missed medication).
For the past 1 yr, she cannot walk more than 100mts. On walking at a stretch there is palpitation and SOB.
She is non-diabetic. She eats paan with only nutmeg and slaked lime only, Once a day, 3-4 times/wk.
CURRENT CHIEF PROBLEMS AND PATIENT'S REQ.:
2 wk ago, she c/o palpitation and uneasiness. Her BP was found to be 90/60 mmHg. Again 1 wk ago, after waking up she c/o uneasiness, lightheadedness with chest tightness (?angina), which lasted for more than 20 mins. Her BP was found to be low. The cardiologist did Trop - T (found +ve) and ECG. After staying in the hospital for 4-5 days she was recommended to do angiography and discharged with medications. Referred to another hospital.
For the past 1 wk, she is also c/o a feeling of chest tightness while sleeping along with SOB, lightheadedness, and pin and needle sensation in her limbs. She feels better sitting up or standing. Also, she feels bloated (more after a meal) and globus sensation.
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FAMILY HISTORY: No one in her family has any heart ailment or DM. Her brother has hypotension.
REPORTS:
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