A 40 Year old women with chest pain

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Pt came with a c/o of

 chest pain since 1 day

HOPI-

pt was asymptomatic 1day ago then had chestpain after having tea which is burning type,non radiating, aggravats after intake of food during that episode she have sweating and palpitations  and also had 1 episode vomiting which contains food ,non projectile,non bilious then had sob (grade 2-3) 

H/o pain over epigastric region which is burning type ,non radiating

H/o weight loss from past 2months

no sweating,no pedal edema

Past history

Not a k/c/o htn,dm,tb, epilepsy,cad, thyroid 

H/o similar complaints of chest pain 10-15 days back for which she sought medical help was found to have anemia for which iron sucrosee injection were given 

H/o palpitations on walking and sob on exertion since 2yrs

Personal history

Diet mixed 

Appetite normal

Bowel and bladder -regular

General examination

Patient is conscious, coherent, cooperative

Pallor is present

No icterus, cyanosis, lymphadenopathy,edema of feet

Vital 

Bp 100/70mm hg

Pr 72bpm

Rr 18cpm

Systemic examination

Cvs s1s2 heard,no murmur

Rs BAE present

Pa soft nontender

Cns nfnd

Investigation

ecg

USG

Impression 

Left simple renal cortical cyst

Finding

O/e 11×7mm cyst mid pile left kidney

2d echo

EF 64%

No MR,TR,AR

No diastolic dysfunction 

Good LV function

No rwma

Provisional diagnosis

Acid peptic disease 

Treatment

Iv fluid ns

Tab.Ultracet 1/2  po qid

2/4/23

S

Her chest pain has reduced,low grade fever was noticed only once for which we recommended tapid sponging and now she is afebrile (98.4f)

O 

Pt is c/c/c

Pr 84bpm

Rr 18 cpm

Bp 90/60mm hg

Grbs 99mg/dl

Cvs s1s2 heard no murmur

Cns nfnd hmf intact

Rs BAE present nvbs

P/a soft nontender

A

Acid peptic disease 

P 

Tab.Ultracet 1/2 qid

Tab.neurobion forte po /oD/Hs

4/5/23

S:

Her chest pain has subsided 

No fever spikes 

Stools passed 

O :

Pt is c/c/c

Pr :78bpm

Rr :16 cpm

Bp :90/60mm hg

Grbs:88mg/dl

Cvs :s1s2 heard ,no murmur

Cns :nfnd hmf intact

Rs :BAE present ,nvbs

P/A:soft ,nontender

A:

Acid peptic disease 

P 

1)Tab.Ultracet 1/2 qid

2)Tab.Pan 40mg/Po/OD before food 

3)Tab.neurobion forte po /oD/Hs

5/5/23

S:

Her chest pain has subsided 

No fever spikes 

Stools passed 

O :

Pt is c/c/c

Pr :78bpm

Rr :16 cpm

Bp :90/60mm hg

Grbs:88mg/dl

Cvs :s1s2 heard ,no murmur

Cns :nfnd hmf intact

Rs :BAE present ,nvbs

P/A:soft ,nontender

A:

Acid peptic disease 

P 

Tab.Pan 40mg/Po/OD before food