54 yr/F with chest pain

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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings investigations and come up with diagnosis and treatment plan

C/O-

Chest pain since 2 -3years

HOPI

Patient was apparently asymptomatic 3 yrs back then she developed chest pain, which dragging type,insidious in onset and gradually progressive in nature associated with Epigastric pain,abdominal bloating and SOB

SOB increased after consuming food

No C/o belching,nausea and vomiting

C/O pain in B/L knee joints since 3 years

C/O lower backache, wrist joint pain

No C/O Tingling sensation of hand and feet

C/O decreased appetite( patient says she avoids eating)

C/o palpitations, Generalized body pains

C/O polyuria,polyphagiaand polydipsia no c/o burning mitcuration, Giddiness and sweating

No C/O weight loss/gain,constipation/loose stools, cold/heat intolerance

PAST HISTORY

patient is a K/C/O DM2 since 2 years (not on medication since 3 months,unknown medication)

Not a K/C/O HTN,CVA,CAD,thyroid disorder, asthma ,TB and Epilepsy