 |  q1
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| Author | 6 Posts |
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A 55-yr old man with a long history of poorly controlled hypertension suddenly develops severe retrosternal chest pain that raidates into the upper back bewteen the scapulae. On examination he has diaphoresis and severe SOB. Pulse is 125 / min & regular, BP 130/60mmHg left arm and 80/50mmHg in the right arm. There are diffuse, wet, inspiratory crackles in both lung fields, distand heart sounds and a perviously undetected grade 2/6 blowing, early diastolic murmur in the 2nd right and 3rd left intercostal spaces adjacent to the sternum. The most like diagnosis is?
A.) dissecting aortic aneurysm
B.) MI
C.) Pericarditis with tamponade
D.) Pulmonary embolism
E.) Ruptured chordae tendineae
F.) Ventricular septal rupture
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| meg
Forum Guru
Topics: 62
Posts: 806
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1)
The pain is typical(abrupt onset of retrosternal pain radiating to upper back). The dissection might be close to the aortic valve, hence the aortic insufficiency (blowing early diastolic murmur in aortic ausculatory regions). Also the dissection is leaking into the pericardial space, causing tamponade(distant heart sounds), compromising the expansion of the heart(wet inspiratory crackles).
The dissection seems to be sparing the blood supply to the left subclavian against the right subclavian, hence different blood pressures.
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The criterion for temponade:
pulses paradox, hypotension and SOB
kinda looks like a temaponade, not from pericarditis though.
A can be a diangnosis of exclusion
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| alice8
Forum Guru
Topics: 37
Posts: 643
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A.) dissecting aortic aneurysm :?:
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| Dan Ivanov
Forum Senior
Topics: 14
Posts: 106
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Hey Guest, if you could tell me what "SOB" means...
Thx
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Dan
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its there in the question, shortness of breath
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