We often talk about any situation when something goes wrong, as Murphy's Law, 'If anything can go wrong, ,it will!' Nothing is exception to this statement and medicine is also not exception.But I often say that sometimes it is better to not know everything, but know what patient DOES NOT HAVE. So when I see some patients and have some symptoms and I can not find exact reason for it , I tell them that I don't know what you have , but it is not serious. That brings me to the story of one my patient.
He was a young male and has not been smoker.He was fine till one day when he was working on a house . He was hard working - physically hard working male and he used to buy homes and work on them and then sale them. So one day when it was little cold in Florida, he was working on a house. He was out side and so he had a jacket and was working and he noticed that he felt hot and took out the jacket and he noticed that he was sweating . He had some shortness of breath. No major chest pain. He saw his primary care physician and was told to get COVID test done . He had no fever and no cough and no other problems . He did the test and that was OK . He was told to see me or may be he decided to see me. I asked him on any chest pain and he did tell me that he had some chest pain but it was short lasting but now he has some more shortness of breath.I examined him and his blood pressure was normal, he had no fever and he had good oxygen saturation and his lungs were clear and he had no wheezing like asthma.He had normal heart sounds and there was nothing abnormal on physical examination.I thought that his symptoms were atypical and did not look like lung problem ,but he was short of breath on doing things that he could do without efforts in past.I thought that he could still have mild asthma , but it was not very clear cut.So I decided to do work up. He had COVID test and that was negative. He had no cough and no fever and lungs were clear. I ordered CT scan of chest and a breathing test and also pulmonary stress test. I gave him an inhaler to help breathing in case he had asthma. The breathing test was normal and the CT scan showed some abnormality. He had what was described as 'ground glass densities' The ground glass densities is very small areas of ' haziness' The window glass is clear and the shower glass door is not clear . So that is called ground glass density. I could not figure out as to what might have caused this and infection could be one of them and so I spoke to him and he told me that he was little better but was still short of breath and he had no new complaints . I ordered some antibiotics and told him that he needs to see cardiologist ASAP as I was concerned that he may have heart problem , the sweating and shortness of breath and some chest pain all could be due to coronary artery disease . So I called a cardiologist to see him soon. He was seen in 1 day and the cardiologist was convinced that he HAD SEVERE CORONARY ARTERY DISEASE. and wanted to do cardiac cath. to find out any blockage. But all the slots were filled in the lab. and so he admitted him of Friday, the day that he saw and did procedure on Saturday. HE HAD SEVERE BLOCHAGE IN THE CORONARY ARTERIES AND NEEDED surgery!
So I knew that this was not lung problem and suspected it was heart, but was not sure .
So one must know what it is not even if one does not know what it is.