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ccssa form 2q

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13 Posts

usmle6789
Forum Senior

Topics: 33
Posts: 49

01/22/05 - 07:27 AM

59 yr old woman comes to ER 45 mts after the onset of chest discomfort that is not relieved by 3 nitroglycerine tabs. Over the past 3 months she had similar episodes characterized by nonradiating pain and a feeling of heaviness. The episodes were exacerbated by exertion or heavy meals and were slowly relieved by rest. Sublingual nitroglycerine provided rapid relief of symptoms in the past. She has hypercholesterolemia, type 2 DM, PUD. She smoked 2 packs of cigarettes daily for 25 yrs but quit 5 yrs ago. She appears anxious, diaphoretic and nauseated. Examination shows no other abnormalities except for an S4. Most likely diagnosis?

1] Acute aortic dissection
2] Angina pectoris
3] Esophageal spasm
4] MI
5] PE

lucky
Forum Guru

Topics: 23
Posts: 505

01/22/05 - 08:31 AM

esophageal spasm

ELM
Forum Guru

Topics: 28
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01/22/05 - 11:40 AM

S 4 indicates heart problem-----> i would pick 4 over 2..... seems she is in moderate distress.

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tamriko
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Topics: 23
Posts: 296

01/23/05 - 06:38 AM

think you are right ELM, its MI

mdwannabe
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01/27/05 - 12:02 PM

I d go for MI... to much distress for Esoph spasm.

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Veer-Zaara
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Topics: 16
Posts: 268

01/28/05 - 03:41 AM

I think its MI too.

drk1980
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07/25/06 - 04:35 AM

and also the nitrates would help relieve eso spasm in case tht ws the problm.

mazinger
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07/25/06 - 08:05 AM

The only way to diferentiate for sure between MI or unstable angina is through EKG, is there something in the vignette that would help us to tell them apart?
Is the S4 more related to one of these?

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AAAAA
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Topics: 153
Posts: 1,983

07/25/06 - 09:08 AM

mazinger wrote:
The only way to diferentiate for sure between MI or unstable angina is through EKG, is there something in the vignette that would help us to tell them apart?
Is the S4 more related to one of these?

The answer is MI and no where did they show unstable angina.

Angina pectoris means chest pain ! Not necessary unstable chest pain onto heart attact in layman term !

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AAAAA
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Topics: 153
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07/25/06 - 09:10 AM

#10

Absolutely not true. have you heard of Non-STT wave MI, silent MI?

There are sooo many people had heart attack . small ones, subendothelial MI and they never knew !

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frank100
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07/25/06 - 10:20 AM

#11

mazinger
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Topics: 46
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07/25/06 - 10:42 AM

#12

Well AAAAA I think you have a point here Im not a cardiologist or anything, but looking from a simple perspective thats what Dr Fischer said on kaplan videos...
And no I havent heard of many things in medicine, thats why I keep trying hard on a daily basis, and try to solve riddles in an open forum...
And you are right theres no unstable angina in the options, hehehehe reading fast is bad habit I should improve...

Edited by mazinger on 07/25/06 - 12:19 PM

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drsap
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Topics: 3
Posts: 36

07/25/06 - 11:35 AM

#13

MI. duration of pain is also a point to consider.

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