History of Presenting Illness
A 50-year-old male who hails from Bihar, studied up to 8th standard, presently working as a car driver.
He complain about his chest pain that happen when he suddenly felt a vague chest pain present at the
center of the chest. Pain was located in the substernal location and was radiating to the right side of the
shoulder. The quality of the pain was dull aching, which was increasing in severity rapidly over few
hours. The patient is conscious, oriented and a bit anxious, vital signs are: BP 138/94 mmHg, PR
120/min, RR 34/min.
Past history
The patient is not a known diabetic, or hypertensive. He has had no similar history in the past. There was
no history of any angina on exertion or dyspnea previously. There was no history of fever, joint pains,
involuntary movements, rash, or nodules. There was no history of tuberculosis and bronchial asthma in
the past. There was no past surgical history.
Treatment history
The patient is not on any medications. There was no history of any intake of any cardiotoxic drugs
(cancer chemotherapy or prolonged steroids).
Personal history
The patient takes mixed diet and
smokes 1 packet cigarette/
day for the last 15 years. There was no
alleged history of any
alcohol or illicit drug abuse.
Personal history
The patient takes mixed diet and smokes 1 packet cigarette/day for the last 15 years. There was no
alleged history of any alcohol or illicit drug abuse.
General examination
• The Patient was average built, is conscious, is oriented, and is anxious at rest
• He was afebrile
• There was no pallor, icterus, cyanosis, clubbing, edema, or lymphadenopathy
• There were no markers of atherosclerosis (xanthoma, xanthelasma, Arcus juvenilis, and franks sign)
• There were no markers of congenital heart disease (low set ears, hypertelorism, epicanthal folds, and
limb deformities)
• There were no markers of rheumatic fever, (IE) Infective endocarditis
• Height – 154 cm
• Weight – 70 kg
• BMI – 29.2
• Upper segment – 80 cm
• Lower segment – 74
• Arm span – 150 cm.
Cardiovascular examination
Inspection
Chest wall is bilaterally symmetrical, and there is no kyphoscoliosis. Trachea is slightly shifted to right.
Apex is not visible due to mild obesity. There are no dilated veins or scars.
Palpation
Inspection ndings are con rmed.
Apex is located in the
5th intercostal space ½ inch medial to
mid clavicular line.
There is no parasternal heave or any
epigastric pulsations, no
palpable sounds or thrills
Inspection ndings are conrmed. Apex is located in the 5th intercostal space ½ inch medial to mid
clavicular line. There is no parasternal heave or any epigastric pulsations, no palpable sounds or thrills
Percussion
Right heart border corresponds to the right border of sternum. Left heart border corresponds to apex.
Pulmonary area is resonant on percussion. Liver dullness is present on right and gastric tympany on left.
Auscultation
1st heart sound is loud in intensity (tachycardia) and 2nd heart sound is normal in intensity had a normal
split) there is tachycardia. There are no added sounds, or murmur
Respiratory system
There was bilateral air entry equally. Normal vesicular breath sounds heard at bases of lung. There were
no added sounds like crepitation’s or wheeze
Abdomen
Soft, nontender. No organomegaly noted
Central nervous
systemThe patient was conscious, well oriented to time, place person and had no focal neurological
decit
