A 40 yr old patient came with chief complaints of giddiness and abdominal discomfort

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40 yr old patient came with chief complaints of-

C/o generalised weakness since 2 days 

C/o giddiness since 2 days 

C/o abdominal discomfort since 1 day 

HOPI-

Pt was apparently a symptomatic 2 days ago. She then developed giddiness which is sudden in onset(rotational) generalised weakness since 2 days. Pt went to a local hospital and was found to have high BP and was treated. After 6hrs, pt had severe giddiness and on evaluation there was low BP and was admitted. Pt had severe episodes of severe giddiness, no variation with position change associated with intermittent headache. 

H/o decreased appetite, abdominal bloating with severe abdominal discomfort relieved on eating. 

HISTORY OF PAST ILLNESS- 

Pt has been having the symptoms of abdominal discomfort with burning sensation on and off since 1 yr

Recently she had similar complaints 1 month back which was relieved on medication

H/o usage of anti hypertensive medication 1 month back for 5 days 

Not a known case of DM,Asthma, TB, epilepsy,CVA,CAD, thyroid dysfunction.

SURGICAL HISTORY- 

1 lower segment c- section done 21 yrs back

No h/o any blood transfusions 

PERSONAL HISTORY-

Appetite- normal

Diet- mixed 

Bowel and bladder- regular

Sleep- inadequate 

Addictions-

Alcohol- occasionally drinks toddy /beer (once a month) 

No h/o smoking/ drug abuse 

FAMILY HISTORY- 

No significant family history

MENSTRUAL HISTORY-

Age of menarche- 13 yrs 

Menstrual cycle- duration of cycle/ no. Of days bleeding

        Normal flow, regular with no clots 

LMP- 11/4/23

OBSTETRIC HISTORY- 

2 children- 1 normal delivery 1 C- section 

PHYSICAL EXAMINATION-

GENERAL EXAMINATION- 

Pt is conscious, coherent, cooperative.

Pallor- absent

Icterus- absent 

Cyanosis- absent 

Clubbing- absent 

Lymphadenopathy- absent 

Edema- absent 

VITALS-

Temperature- 96.8

Pulse rate- 66 bpm

Respiratory rate- 16 cpm

SYSTEMIC EXAMINATION-

ABDOMEN-

Inspection-

Shape of abdomen- obese

Umbilicus- central and inverted 

presence of C- section scar and striae 

Flanks are free

No engorged veins

Movement of abdominal wall are normal

No visible gastric peristalsis 

Palpation-

Superficial palpation-

No tenderness, no raised temperature 

Deep palpation- 

No organomegaly 

Percussion-

No fluid thrill 

On shifting dullness- tympanic note 

Auscultation- 

Bowel sounds are heard 7/ min 

Bruit- no renal artery bruit , iliac artery bruit.

CVS-

Cardiac sounds- s1 and s2 heard 

No cardiac murmurs 

Bp is paroxysmal 

INVESTIGATIONS- 

ECG 

2D ECHO