young_doc
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1. A 72-year-old man comes to the emergency department with severe mid-back pain, radiating around to the front of the chest, of 3 days' duration that did not respond to treatment with a nonsteroidal anti-inflammatory drug. He survived an uncomplicated inferior myocardial infarction 2 years ago. His medications include metoprolol, simvastatin, aspirin, and ramipril.
On physical examination, blood pressure is 160/70 mm Hg and heart rate is 66/min, with occasional extra systoles. An apical impulse is noted 1 cm lateral to the midclavicular line. An S4 is present. The remainder of the physical examination, including measurement of the peripheral pulses, is unremarkable.
The troponin I level is less than 0.3 µg/L, blood urea nitrogen level is 22 mg/dL, and creatinine level is 1.1 mg/dL. Electrocardiogram shows sinus rhythm and inferior Q-wave progression, consistent with a previous inferior myocardial infarction. This finding is unchanged from the one obtained 1 year earlier. Chest radiograph shows a midline retrocardiac density.
Which of the following is the most appropriate initial diagnostic study?
( A ) Cardiac catheterization
( B ) Dipyridamole myocardial perfusion scan
( C ) Helical chest computed tomography scan with contrast
( D ) Lumbar spine magnetic resonance imaging scan
( E ) Lumbar spine x-ray
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Forum Fanatic
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Posts: 2,324
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Could be thoracic aorta problems...
( C ) Helical chest computed tomography scan with contrast
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