66F HTN 10 YRS ecg incidental IWMI

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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.

 A 66 year old  female who is home maker came to  opd for general checkup.

HOPI:

Patient was apparently asymptomatic 10 years back then she was diagnosed as Hypertensive .She is on Amlodipine 2.5 mg  once daily.

Few days back, as a part of general checkup ECG Showed MI changes(silent MI changes).

No C/o chest pain, palpitations,SOB,sweating.

Past history:

Known case of Hypertension since 10 years on amlodipine 2.5 mg.

Not a known case of DM,TB,Epilepsy ,CVA,CAD,Asthma.

Daily Routine:

She is a House wife, she wakes ups at 5AM in the morning, she engages in some spiritual activities (prayers) from 5AM to 7 AM .Then she does her daily household work and she has breakfast at 8:30 AM . She usually has upma ,Idilli,Dosa, for her breakfast. she then gets engaged with household works like washing clothes,preparing lunch and she has lunch at 1PM(Rice item),then she takes rest till 5:00PM .In the evenings she usually has tea then she goes for walking from 5:30PM to 6:30 PM and comes home and prepares dinner and has dinner at around 8:00PM along with her family. she usually has Roti  and rice for  her dinner.She goes to sleeps around  9:30 PM.

Clinical images:

Personal History:

Diet: Mixed

Appetite:Normal

Sleep: adequate 

Bowel and bladder: regular.

No addictions.

Vitals:

BP:140/90 mm hg

PR: 82 bpm

RR :17 cpm

Temp:afebrile.

General examination:

Pallor present,no icterus,clubbing,cyanosis,lymphadenopathy,Edema

Systemic Examination:

Cvs:S1,S2 heard,no murmurs

RS:Bilateral Air entry present,Normal vesicular Breathsounds heard

Per Abdomen:

Soft , Obese,No tender ,No Organomegaly

Cns:No Abnormality detected

Investigations:

Ecg:

X ray: