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  #1  
Old 03-22-2012
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Heart Hypertensive man with excruciating chest pain

A 55-year-old hypertensive man comes to the emergency department with complaints of sudden onset of excruciating pain beginning in the anterior chest, and then radiating to the back. Over the next 2 hours, the pain moves downward toward the abdomen. On history, the man states that his family physician started him on a low-dose ibuprofen for wrist pain that started last week. Which of the following is the most likely diagnosis?

A) Aortic dissection
B) Aortic valve stenosis
C) Atherosclerotic aneurysm
D) Myocardial infarction
E) Syphilitic aneurysm
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  #2  
Old 03-22-2012
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Aortic dissection
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Old 03-22-2012
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yes .........A...........
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  #4  
Old 03-22-2012
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Cool

Aortic dissection.
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Old 03-23-2012
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The correct answer is A. This patient has an aortic dissection (formerly called dissecting aneurysm), a potentially fatal condition that is too often confused clinically with myocardial infarction. The most important clinical clue is that the pain shifts with time. Noninvasive techniques, such as transesophageal echocardiography, CT, and MRI, are increasingly useful in making this diagnosis.

Aortic valve stenosis (choice B) would not be expected to produce severe chest pain of acute onset.

This patient's clinical history does not suggest either an atherosclerotic (choice C) or a syphilitic (choice E) aneurysm. Even if he had one of either of these types of aneurysms and it had begun to rupture, the distinctive feature of severe pain moving downward would probably not be present.

Myocardial infarction (choice D) is the major diagnosis most often confused with this patient's condition. The movement of the pain is the major clinical tip-off suggesting that this is not the correct answer.
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  #6  
Old 03-23-2012
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Help

does the ibuprofen or the wrist pain have anything do with this...?
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  #7  
Old 03-23-2012
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Quote:
Originally Posted by BritneySpears View Post
does the ibuprofen or the wrist pain have anything do with this...?
I don't believe so. Either way, a hypertensive pt with pain radiating to the back are the buzz words here.
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Old 03-23-2012
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I know

but maybe the wrist pain is due to poor circulation if the dissection had a subtle start back then..?
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Old 03-23-2012
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Quote:
Originally Posted by BritneySpears View Post
does the ibuprofen or the wrist pain have anything do with this...?
No, that was just a distracter !!
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  #10  
Old 03-23-2012
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;_;.................
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