macTT
Forum Senior
Topics: 32
Posts: 86
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A 53 yr old obese lady who has hypertension is brought to the E.R after collapsing. Prior to admission, she complained of an excrutiating. stabbing chest pain radiating to the left shoulder. She is anxious and in severe pain. Pulse is 110/min and B.P is 160/80 mmHg. On Ausculation, heart sounds are distant and pulsus paradoxus present. ECG shows low voltage and ST wave changes. An x-ray film shows widening of the mediastiunum. The most likely diagnosis is?
A) Aortic dissection w/ temponade
B) Hypertensive crises
C) Massive pulmonary thromboembolism
D) myocardial infarction w/ CHF
E) rupture of papillary muscle.
Sorry if this has been discussed b4. I know the answer is A but how come the pain is not radiating to the back? Why can't be a MI?
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| arunangsude
Forum Newbie
Topics: 0
Posts: 9
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i think main hint is pulsus paradoxus
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| macTT
Forum Senior
Topics: 32
Posts: 86
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Yes that is a big hint,
However, I am curious why they didn't mention radiation to the back? Since it is dissecting
JACK
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| me007
Forum Guru
Topics: 72
Posts: 799
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it is about types of dissection
type A aneurism - MC and worst type, involves ascending aorta, site of rupture - pericardial sac
type B aneurism - begin below subclavian artery and extend distally - what i guess will radiate into the back
correct me if i wrong
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| macTT
Forum Senior
Topics: 32
Posts: 86
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ME 007,
I guess that explains it....thx for the clarification. DIdn't know that there are actually 2 types of disscetion.
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| medocuk
IM-RES
Topics: 26
Posts: 1,467
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Also for MI they would have given a better clearer picture. Low voltage doesn't fit an MI picture but does so for an aneurysm.
You wouldn't see widening of the mediastinum either in MI.So except for radiation all the clues go in favour of a.
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| what to do
Forum Senior
Topics: 29
Posts: 91
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why u guys are looking for MI. then gave distinct feature for pericardial effusion. heart sounds are distant and pulsus paradoxus present. ECG shows low voltage and ST wave changes. An x-ray film shows widening of the mediastiunum. this is specific. until unless First aid is wrong.  
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saif
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