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  #1  
Old 11-25-2011
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EKG EKG of Chest Pain that radiates to back!

A 75-year-old patient with longstanding poorly-controlled hypertension presents with diaphoresis and severe chest pain which radiates to the back between his shoulder blades. An electrocardiogram is obtained. Chest x-ray reveals a widened mediastinum. In this patient, which of the following statements is true?
  • A. He has a false lumen within the aortic media
  • B. He has coronary artery plaque thromboses
  • C. He has blood filling in pericardial sac
  • D. He has coronary artery vasospasm
  • E. Hes troponin I levels will be elevated
EKG of Chest Pain that radiates to back!-ekg-image.jpg
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  #2  
Old 11-25-2011
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A. He has a false lumen within the aortic media
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  #3  
Old 11-25-2011
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A...false lumen
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  #4  
Old 11-25-2011
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A. He has a false lumen within the aortic media

Aortic dissection
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  #5  
Old 11-25-2011
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can someone explain the findings in the ECG?, i think there are pathological Q waves
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Old 11-28-2011
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Default why is A

can anyone explain the reason?
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  #7  
Old 11-28-2011
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Yup it is aortic dissection false lumen within the aortic media
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Old 11-28-2011
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a. the ekg shown is just to show no ST depression, elevation.
the enlarged mediastinum gave me the answer.
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Old 11-29-2011
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can anyone explain the EKG more clearly? Is it completely normal or any changes which are nonspecific?........If its aortic dissection then are there any EKG changes which would relate to the pathology?
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Old 11-29-2011
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Default ekg normal

yup aortic dissection and the ekg looks normal to me.. (for people askin abt it)
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Old 11-29-2011
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Quote:
Originally Posted by MANIAKOS View Post
can someone explain the findings in the ECG?, i think there are pathological Q waves
u dont even need to glance at the ecg!!
the scenario is enough to chose aortic dessection!
mug it up
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  #12  
Old 11-29-2011
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I agree with everyone who chose because this patient has aortic dissection suggested by the widened media stinum in the CXR + no ST-T changes on ECG that might suggest ACS
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Old 11-30-2011
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Quote:
Originally Posted by shyangel18 View Post
u dont even need to glance at the ecg!!
the scenario is enough to chose aortic dessection!
mug it up

Ι agree with you...I was just curious about the ECG ...
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  #14  
Old 11-30-2011
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he has a false lumen within the aortic media
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Old 12-01-2011
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I believe the correct answer is A. aortic dissection.
We can rule out acute coronary syndrome or vasospasm cause there's no ST-T changes.
In pericardial effusion there's usually low voltage and ST-T changes, so we can rule this out also.
However there's a problem with choice E, troponin can be elevated in aortic dissection.
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  #16  
Old 02-20-2012
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as there is mediastinal widening so i with aortic dissection, but there is Q waves in lead II,III and in aVF which can occur in non ST elevation inf surface MI, why everybody is concerned about only st elevation?
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  #17  
Old 02-21-2012
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Quote:
Originally Posted by N Nur View Post
as there is mediastinal widening so i with aortic dissection, but there is Q waves in lead II,III and in aVF which can occur in non ST elevation inf surface MI, why everybody is concerned about only st elevation?
Q-waves are not an acute event, they usually mean completed MI or old MI
It's also nearly always that Q-waves develope after ST-elevation MI because for Q-wave to develope, transmural (ST-elevation) and not sub-endocardial (non-ST- elevation) should develope
There is no need at all to have a concern of Ischemic pain in the acute setting only because of Q-waves because they need time to develope, rather we should focus on other signs (e.g. Cardiac enzymes, type of pain CXR, ....etc)
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  #18  
Old 02-21-2012
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aortic dissection... with normal EKG. Typical presentation.
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Old 02-21-2012
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Default why is the EKG normal..?

Easy.. contrary to what Goljan said... EKG and/or Rx are not the way to Dx aortic dissection because they have a sensitivity around 70-80%. The gold standard is: CT, MRI and TEE (Better to worst order). Also, AA is a diagnosis of suspicion... Think of it if a patient has long standing HT and a sudden onset of chest pain that irradiates to the back. If you think/suspect that the patients has an AA... then you must proceed as it was one until you make sure is not. If you think is an MI and you go and anticoagulate the patient... you will kill him for sure.

Rx widening: what if the Rx are normal? would that ruled out AA... No, you cannot relay on Rx to make the diagnosis.

Troponin I: careful, this can be normal in AA. Plus, if you correlate the EKG with the presentation: chest pain that irradiates, long standing HT, >65 years old and normal EKG... think in AA, you see an abnormal chest Rx... the next thing to consider is CT to confirm or rule out.
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  #20  
Old 06-27-2012
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A. He has a false lumen within the aortic media
Aortic dissection - pain radiating to back with with wide mediastinum on cxr.
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