60 yr old male with lower back ache and shortness of breath
 
 A 60 yr old male resident of daily wage labourer  by occupation came with chief complaints of lower back ache since 10 days and shortness of breath since 5 days  HISTORY OF PRESENTING ILLNESS  Pt was apparently asymptomatic 6 months back the he developed sudden onset of chest pain with high blood pressure and was diagnosed with MI and PTCA was done . Now since 5 days she developed sudden onset of chest pain and shortness of breath Chest pain is retrosternal,non radiating Shortness of breath since 5 days grade ll to grade lll , PAST HISTORY K/c/o DM since 10 years  PERSONAL HISTORY Diet  mixed Appetite Normal Sleep  adequate Bowel and bladder Regular Addictions alcoholic since 20 yrs 70ml/day and smoker since 20 yrs 2 chutta/day  GENERAL EXAMINATION Patient is conscious coherent and cooperative Moderately built and nourished No pallor, Icterus, cyanosis, generalized lymphadenopathy,edema  Mild clubbing is present Vitals  Temp Afebrile Bp...
