3. History
A 44-year-old male presented to OPD with
Shortness of breath for 1 year
History
General Physical
Examination
Systemic Examination Investigations Treatment
4. History of Present Illness
• My patient was in his usual state of health 1 year back
when he developed shortness of breath which was
• More on exertion
• Progressive (first he could take stairs, now taking few stairs
causes worsening of SOB)
• Not associated with dyspnea on lying flat or sudden night
wakening due to dyspnea
• Associated with palpitations and chest pain
History
General Physical
Examination
Systemic Examination Investigations Treatment
5. Past
History• He has been admitted in hospital 3 times for syncope
• History of irregular heart beats since last year.
Treatment History
Lisinopril (ACE inhibitor)
Metoprolol 50mg/day
Aspirin 325mg/day
History
General Physical
Examination
Systemic Examination Investigations Treatment
6. • Personal History
• Real state agent
• Smoker
• Addict
• Family History
• Married, 4 Children
• H/O sudden death of brother at the age of 22
• Ischemic Heart Disease
History
General Physical
Examination
Systemic Examination Investigations Treatment
8. General Physical Examination
• A healthy looking man of average height and built is lying
comfortably in bed fully oriented in time, place & person
• Vitals
• Pulse: 94/min
• Blood pressure: 132/82
• Respiratory Rate: 22/min
• Temperature: 98°F
History
General Physical
Examination
Systemic Examination Investigations Treatment
9. • No Pallor, Cyanosis, Clubbing, Koilonychia, Leuconychia,
Splinter Hemorrhage, Pitting of nails.
• No Osler's Nodes, Heberden's Nodes, Bouchard's Nodes,
Joint Swelling, Deformitiy
• No puffiness, xanthalasmas, jaundice, rash, parotid
swelling, proptosis, hirsutism.
• No thyroid swelling, neck veins engorgement, JVP not
raised.
• No lymph nodes palpable. No Edema
History
General Physical
Examination
Systemic Examination Investigations Treatment
11. Cardiovascular System
• Pulse
Pulse is 94/min, regular, normal volume, but jerky with no radio-
radial or radio-femoral delay and vessel wall is not palpable.
• Inspection
No bulging, scars, visible pulsations.
History
General Physical
Examination
Systemic Examination Investigations Treatment
12. • Palpation
Apex beat is palpable in 5th ICS at mid clavicularline and is heaving
in character. No left parasternal heave. No palpable heart sounds.
• Auscultation
Normal first and second heart sound and fourth (S4) heart sound.
Grade 3/6 ejection systolic murmur that increased with the
Valsalva maneuver and decreases wit squatting was best heard in
the third intercostal space left of sternum.
History
General Physical
Examination
Systemic Examination Investigations Treatment
13. Resp. System, GIT and CNS
•Normal
History
General Physical
Examination
Systemic Examination Investigations Treatment
15. Investigations
• ECG
• Echocardiogram
History
General Physical
Examination
Systemic Examination Investigations Treatment
• Asymmetric septal hypertrophy
• Mild systolic anterior motion of mitral valve with LVOT
obstruction was present
• Mild mitral regurgitation is also seen
• Right ventricle was of normal size and function
