T.sharath 189 70 YEAR OLD MALE WITH EPIGASTRIC PAIN SINCE 1 YEAR AND DYSNPNEA This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome." CHIEF COMPLAINTS 1. Dyspnea at rest since 2 years 2.epigastric pain since 1 year 3.water brash since 1 year HISTORY OF PRESENTING ILLNESS Patient is a resident of Nalgonda , a unskilled labourer by occupation for the last 50 years he was apparently leading a normal life until 2 years back when he developed shortness of breath on doing more than ordinary physical activity , (grade