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  #1  
Old 05-18-2011
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Heart cardiology : question best initial test

A 76-year-old male comes to the emergency room with sudden onset of severe chest pain. The pain is 10/10 in severity, tearing in quality, and radiates to the back. He is a known diabetic for 10 years and is hypertensive for 8 years. His medications include insulin, metoprolol and hydrochlorothiazide. His vitals are, PR: 86/min; BP: 166/96 mmHg in his right arm and 136/70 in his left arm; Temperature: 37C(98.6F); RR: 14/min. On auscultation, lung fields are clear and heart sounds are normal without any murmurs. you suspect Aortic dissection..
what is the best initial test for this patient?
What is the most accurate test?

a.chest X ray
b. ECG
c. TEE
d. CT angiography.

answer as---a/a,a/d, etc

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Old 05-18-2011
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C:TEE
TEEs are excellent, accurate tests
The first test most physicians will request will be a chest x-ray( chest x-ray can show signs that will increase a physician's suspicion for a dissection)
Aortography involves the injection of dye directly into the aorta. The dye is highlighted on a series of x-rays. However, it is an invasive test and accurate
no EKG findings that diagnose an aortic dissection
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Old 05-18-2011
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Quote:
Originally Posted by miss patho View Post
C:TEE
TEEs are excellent, accurate tests
The first test most physicians will request will be a chest x-ray( chest x-ray can show signs that will increase a physician's suspicion for a dissection)
Aortography involves the injection of dye directly into the aorta. The dye is highlighted on a series of x-rays. However, it is an invasive test and accurate
no EKG findings that diagnose an aortic dissection

I GOT IT ...BUT WHICH MOST ACCURATE ONE ....TTE OR ct ANGIOGRAPHY..?...please give reference...thanks
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http://www.iradonline.org/diagnosis.html
we usually dont choose the invasive one ( c.t angiography ) as initial accurate
if the choice only C.T or TEE we will choose it as accurate test
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Old 05-19-2011
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Best initial chest xray ..... Show wide mediastinum


most accurate ....... TTE
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Old 05-19-2011
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Best initial test - Chest X-ray (no doubt abt it)
Most accurate test - Angiography (which is not given in ur option)..

the accuracy of TEE, CT angio and MR Angio is the same..
Reference - Master the boards, CK - pafe 103-104..

but as per UW most accurate among ur options will go for TEE...
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Old 05-19-2011
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Quote:
Originally Posted by Dr.kaushik View Post
I GOT IT ...BUT WHICH MOST ACCURATE ONE ....TTE OR ct ANGIOGRAPHY..?...please give reference...thanks
TTE is never the investigation of choice for aortic dissection...
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Old 05-19-2011
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Quote:
Originally Posted by MTBCK View Post
Best initial test - Chest X-ray (no doubt abt it)
Most accurate test - Angiography (which is not given in ur option)..

the accuracy of TEE, CT angio and MR Angio is the same..
Reference - Master the boards, CK - pafe 103-104..

but as per UW most accurate among ur options will go for TEE...

let me make you clear.... as I have been able to clear mine...
1.CT angiography is in the option in the above question...
2. Ct angiography is the most accurate test....as per MTB 3 # page no. 70
3. Angiography aka to refered as CT angiography in such case.
4.TTE is being prefered now a days as per treatment protocol ACP (american college of physician.) as its is almost accurate as CT angiography and beign less invasive and less time consuming.
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Old 05-19-2011
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Quote:
Originally Posted by Dr.kaushik View Post
let me make you clear.... as I have been able to clear mine...
1.CT angiography is in the option in the above question...
2. Ct angiography is the most accurate test....as per MTB 3 # page no. 70
3. Angiography aka to refered as CT angiography in such case.
4.TTE is being prefered now a days as per treatment protocol ACP (american college of physician.) as its is almost accurate as CT angiography and beign less invasive and less time consuming.
point noted...
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Old 05-22-2011
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Default Soooooooooo

Quote:
Originally Posted by Dr.kaushik View Post
let me make you clear.... as I have been able to clear mine...
1.CT angiography is in the option in the above question...
2. Ct angiography is the most accurate test....as per MTB 3 # page no. 70
3. Angiography aka to refered as CT angiography in such case.
4.TTE is being prefered now a days as per treatment protocol ACP (american college of physician.) as its is almost accurate as CT angiography and beign less invasive and less time consuming.

final answer would be TEE if a choice between ....TEE and CT Angio...
???
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Old 05-23-2011
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I'm in favour of CT angiogram because of disadvantages of TTE!

Disadvantages of the TEE include the inability to visualize the distal ascending aorta (the beginning of the aortic arch), and the descending abdominal aorta that lies below the stomach.

MRI is the gold standard.
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Old 05-23-2011
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In a patient with suspected aortic dissection, the aortic root & ascending aorta should imaged first: Evaluation of cardiac function and flow in true/false lumens & potential surgical candidate
Best = TEE

CT is now the most frequently ordered diagnostic imaging modality for the initial evaluation of patients with suspected aortic dissection. Multi-detector row CT is the most rapid diagnostic test for aortic dissection, with data acquisition accomplished in less than 30 seconds. Reported sensitivities and specificities range from 79% to 100% for CT.

In experienced hands, MRI is highly sensitive and specific for aortic dissection. However, MRIs are not universally available and image acquisition time is up to 30 minutes. This relatively prolonged time away from the ED places hemodynamically tenuous patients at risk for delayed aggressive stabilization should they decompensate during the study. Of note, MRI is an observer-dependant technology with reported sensitivities ranging from 52% to 100% depending on the experience of the radiologist

Ref:
1.- Aortic Dissection and Related Syndromes. Springer; 1 edition (December 18, 2006
2.- The utility of multiple imaging modalities to diagnose acute aortic dissection. CJEM 2008;10(1):75-80
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