A 72 yr old female with chest pain radiating to left arm

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HISTORY OF PRESENTING ILLNESS

A 72 year old female came to casuality with chief complaints of fever, vomitings, chest pain radiating to left side since two  days.

Patient was apparently asyptomatic 2 days back later she developed fever which was low-grade, continuous  and relieved on taking medication and not associated with chills and rigor.

She developed chest pain which was pricking type radiating to left arm associated with chest tightness and sweating.

She had episode of vomiting which was non projectile,non bilious ,non foul smelling , containing food particles.

PAST HISTORY 

In 2007 she had NSTEMI and diagnosed with Triple Vessel Disease.She had undergone PTCA(per cutaneous transluminal coronary angioplasty) and CABG(Coronary artery bypass graft).

Again In 2017 she had history of similar complaints and treated conservatively.

She is a known case of Type 2 Diabetes mellitus and Hypertension since 15 years.For which she took Vildagliptin and Metformin(50/500 mg) and Telma 40 mg.

No H/o Asthma, Tuberculosis,Chemo/Radiation, Blood transfusion.

PERSONAL HISTORY

Married

Diet-mixed

Appetite-Normal

Bowel and Bladder movements-regular 

No addictions

FAMILY HISTORY

No relavant family history 

GENERAL EXAMINATION 

Patient was conscious, coherent and cooperative.

No Pallor, Icterus, Clubbing, Cyanosis,Lymphadenopathy.

Vitals:

BP- 130/90 mm Hg

Temp-98°F

PR- 91 bpm

RR-22 cpm

Spo2- 99%

INVESTIGATIONS:

TREATMENT:

Inj HAI 1 ml(40U)+ 39 ml NS at 8ml/hr to maintain GRBS less than 200 mg/dl

IVF 1 unit NS continuous infusion at urine output+30ml/hr 

Tab ECOSPORIN 75MG PO OD

Tab CLOPIDOGREL 75MG PO OD 

Tab CARDIVAS 3.125 MG PO OD 

Inj CLEXANE 60 MG S/C BD for 5 days

Tab MONIT GTN 2.6 MG PO OD  

PROVISIONAL DIAGNOSIS

DKA with Anterior wall MI (NSTEMI)