cirus
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A 42-year-old man from Vietnam, who had been a bus driver in Thailand, presents to the emergency department after having shortness of breath while playing soccer with his son this morning. Over the last several months, he has been having several episodes of shortness of breath. Several of the episodes were associated with chest pain. He denies any significant medical history. He has a 25-pack-year use of tobacco, and he has a sedentary lifestyle. His father had a myocardial infarction at the age of 59. His heart rate is 72/min, blood pressure is 140/66 mm Hg, and respiratory rate is 14/min. His examination shows mild jugulovenous distention with a collapsing carotid arterial pulse. His cardiac examination reveals a point of maximal impulse that is displaced laterally and inferiorly and a mild diastolic blowing murmur at the base while he sits up. His sensory examination shows loss of vibration sense in all extremities, and an abnormal Romberg test. EKG shows normal sinus rhythm with left axis deviation and ST-segment depression and T-wave inversion in leads I, aVL, V5, and V6. The chest x-ray shows an enlarged heart with dilatation of the proximal aorta. The CBC, chemistries, and cardiac enzymes are negative. The echocardiogram shows an ejection fraction of 60%. What is the next best step in the management of this patient?
(A) Treat with digitalis
(B) Exercise stress test
(C) Cardiac catheterization
(D) VDRL and lumbar puncture, followed by penicillin therapy
(E) Aortic valve replacement
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| robin082006
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C
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| cirus
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nop, think again..
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| vrach
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D
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| robin082006
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this patient may has syphilis but also MI
Answer C or D, if not C--> D
But this patient is in acute condition, D is a must but I think it's not emergent.
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| doc_clotaire
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(D) VDRL and lumbar puncture, followed by penicillin therapy ------------
abnormal Romberg test---------------------Aortic syphilis may be
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| Justice
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D
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| kashdoc21
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aortic valve replacement
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| radonc
Forum Senior
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Sounds like syphilis. Answer D.
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