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)