1、Present history : Onset 40-year old male Transient “electric shock like” back and left shoulder pain Syncope Local hospital Present history : hospital 1 Consciousness recovered(one hour after admission) Paroxysmal dull pain in left shoulder and lower back. Present history： hospital 1Neurological Dis
2、orders?Neurological examination was normal.Cerebral computed tomography: normalRadiography: hyperosteogenylumbar hyperosteogeny? Symptoms relieved: dischargedOtherwise NormalPresent history： hospital 2Renal Failure? Chest stiffness & breathlessLower limb edema & oliguria Creatinine: 800mmol/LHemodia
3、lysis RelievedPresent history： hospital 3Cardiomyopathy? Endocarditis？Recurred chest stiffness & breathlessECG: nodal tachycardiaUCG: enlarged heart and aorta, hydropericardium. ？ ？Present history： come to us On January 24th, 2012, the patient came to our hospital. previous history Smoking and drink
4、ing Ceased smoking and abstained from alcohol Denied drug abuse Not aware of any hereditary disease in his family.history： summaryA combination of different clinical findings“Electric shock like” pain (once)Syncope (once)Chest stiffness & BreathlessRepeated low back painPitting edema of lower extremityMonismAnalysis： pluralism Algia： neurological pain？ Acute coronary syndrome？ Syncope： TIA？ Cerebral Infarction？ Oliguria & edema： renal failure? Chest stiffness and pain： ACS? PE?Fractured & confusedAnalysis： monism？
