32 Yrs Old Male with Palpitations and Giddiness




32 Years old  Male Patient labourer by occupation resident of West Bengal 
Came with chief complaints of  awareness of his own heart beat and Giddiness for the past 6 months.

History of Present Illness :
Patient was Apparently Asymptomatic 20 Years Back.Then He developed Headache which initially localised in the Occiput region later Diffused all over which subsided only on taking medication.
Then 6 months back he Developed Palpitation and Giddiness.
 Palpitations were sudden in onset ,and aggravated by Strenous Exercise,Anxiety and slightly relieved on Taking Rest.
Giddiness :
Giddiness was present even on lying down and Sitting Position but Relieved on Medication.
Giddiness also associated with sweating
Past History :
No Similar Complaints in the Past.
No H/O Diabetes, HTN,Asthma ,TB,Epilepsy ,Thyroid.
Family History:
His Sister also had Complaints of Headache since 5 years.

Personal history:
Diet- mixed
Appetite- normal
Sleep- adequate
Bowel and bladder movements - regular.
Addictions-h/o beedi smoking (5-6 times/day) , tobacco chewing and cigarette smoking occassionally since 15 years.
Alcohol intake - 90 ml /day since 15 years.
But he stopped all those for the past 6 months.

Drug history: 
He had taken Metoprolol for palpitations for 2 months. But he stopped the medication due to epigastric pain. 
He had taken medication for anxiety

General examination :
Patient is conscious, coherent and cooperative and well oriented to time , place and person.
Well built and wellnourished.


Physical examination :
Pallor - absent
Icterus - absent
Clubbing - absent
Cyanosis- absent
Lymphadenopathy- absent
Edema - absent.

Vitals:
Pulse rate :88bpm
BP:130/80
Temperature: afebrile
Respiratory Rate:24cpm

Systemic Examination :

CVS :

Inspection :

Shape of Chest and Symmetry - Normal
Breast Abnormality - Absent
Spinal Deformities - Absent
Precordial Prominence
Cardiovascular Pulsations :
Apical Impulse:Not visible
Pulsations in A,P area : absent
Sternoclavicular Pulsations : absent
Left Parasternal Pulsations: absent
Epigastric Pulsations: absent
Distended Veins: absent

Palpation :
Confirmation of Shape and Symmetry 
Palpation of Precordium
Palpation of Cardiovascular Pulsation for Sound ,Thrills and Rubs:not heard
Apical Impulse felt on Palpation
Plaption of Left Parasternal Area - Heaves Absent
Percussion:
Dullness corresponding to Right Heart Border is normal
Dullness Corresponding to left Heart Border is normal
Auscultation :
S1,S2 Heard 
No Murmurs
Investigations:

Drugs

Provisional Diagnosis : panic attack 2⁰ to anxiety disorder 

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