Information was taken from the patient himself 24/10/22 Ziyad Abu zaneh a 38 year old male Patient from Ramallah Presented to ALL MED Clinic this morning complaing of chest pain of three month duration the Pain was located on the left Side of the chest and pinpointed to two locations (Parastrenally and Anterior Axillary told at the level of 5th Intercostal space ). It is stitching in nature 3/10 in Severity with sudden onset when it appears and is episodic each episode lasting a few Seconds having started 3 Months ago with 1-2 episodes frequency Per day While recently its been 2-4 episodes Per day The Pain is localized and does not radiate to anywhere it is not excacerbated by movement or pressure being applied to the Site of pain Nor relived by rest or anything else. accossiated with difficulty breathing and Palpitations (unrelated numbness of the left upper limb). He has no Hx of DM or HTN or Asthma and no Hx of sever illness 1 Surgery done in the past (Appendectomy) 18y ago with no complicationS Patient is not on any Medications and has NKDFA Father died of cancer that seems to have metasizeid at age of 62 ( Grand Father died of the same cause ) He had no HTN and no DMMother is Healthy with no HTN or DM he is a smoker with a 7.5 Pack year hx good living environment does not own Pets sedentary life style has an office job and no recent Hx of travel Systemic Review : CNS was free Respiratory free GIT free Musculoskeletal: said he had neck pain and shoulder pain, but that was all in the past. Genitourinary free DD: most likely Pericordial catch Syndrome physical examination Upon general inspection of the Patient he was conscious alert and well, not in any type of distress, not connected to any device and was in a semi Sitting position. Hand examination his nails fingers and palms were healthy, Examining his arm, he had a regular rhythm with a heart race of +64 bpm no R-R delay andno collapsing pulse Going to the head his eyes were clear of Senile arcus /xanthalsema/ Pallor/jaundice signs, mouth hygeine was good with no cyanosis and no ulcers Neck examination:- no JVP. he had a bounding carotid pulse and no bruit was heard chest examination reveled hypopigmentation Patches on the anterior chest wall, he had no surgical Scars on the chest, pectus excavatum was seen, no heaving (left/right) apex beat was located on the left side 5th intercostal space mid clavicular line Auscultationg the heart using the diaphragm and bell reveled normal S1 and S2 with no added heart sounds (no murmurs, no S3/S4)