40 F WITH COMPLAINTS OF PEDAL EDEMA , BACK ACHE AND CHEST PAIN SINCE 6 MONTHS
C/o pedal edema since 1 year
generalised weakness since 6 months
Backache and chest pain since 6 months
Patient was apparently normal 6 months back
Later developed chest pain non radiating , no aggravating and relieving factors
Back pain non progressive , non radiating , no aggravating factors
C/o pedal edema since 1 year non pitting aggravated on doing work
C/o sob grade 2 , palpitations
C/o constipation
No h/o loose stools, vomiting , fever, cough, cold
No H/o orthopnea, PND , decreased urine output
Past history : DM, HTN, epilepsy , thyroid disease , CVA .
H/0 hysterectomy and spine surgery 8 years back .
Personal history: appetite normal
Diet : mixed
Bowel and bladder regular
Sleep : adequate
Addictions none
Family history : no significant family history
General physical examination
Patient is conscious coherent cooperative well oriented to time place person
No signs of pallor, icterus,clubbing,cyanosis, lymphadenopathy,edema .
Systemic examination:
Cvs s1 and s2 heart sounds heard
CNS no focal neurological deficits noted
Rs BAE + NVBS heard
P/A soft , non tender
Investigations: RFT
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