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Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chestpain radiating to his back. Due to the chestpain radiating into the patient's back, the ER physician ordered CTA chest to rule out aortic dissection. He had associated nausea, vomiting, and dyspnea.
Clinical introduction A man in his 40s with a history of hyperlipidaemia presented with intermittent, dull left-sided chestpain for 2 weeks that was not consistently exertional. Physical examination, an ECG, basic laboratories and a chest X-ray were unremarkable. A transthoracic echocardiogram was performed ( figure 1 ).
Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chestpain. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It started while he was at rest after finishing a workout.
After 24 hours, the patient was readmitted to the hospital with chestpain and troponin elevation, without ECG changes. A transthoracic echocardiogram (TTE) revealed a mobile mass on the right coronary cusp of the aortic valve ( figure 1 , ). Figure 1 A mobile mass (1.88
Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.
He reports significant chestpain at the base of his scapula on the right side along with new shortness of breath. They also wanted an aortic CT which was negative. Wellen's waves indicate that, when the patient was having chestpain, there was occlusion. What do you think the prehospital ECG showed (with pain)?
Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chestpain. Several hours prior to presentation, while driving his truck, he started experiencing new central chestpain, without radiation, aggravating/alleviating factors, or other associated symptoms.
Hopefully a repeat echocardiogram will be performed outpatient. ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of ChestPain and Dyspnea Head On Motor Vehicle Collision. 1900: RBBB and LAFB are almost fully resolved.
It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chestpain, weakness and nausea. Look at the aortic outflow tract. Aortic angiogram did not reveal aortic dissection. What do you see? Answer below in the still shot.
The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chestpain to Dr. McLaren. See this case: what do you think the echocardiogram shows in this case? Left main? 3-vessel disease?
But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chestpain was a little more intense, and the needed recovery period was longer in duration. Aortic Stenosis f. Aortic Stenosis [No Hx syncope, and no systolic murmur] f. Severe Hypoxia b.
The pneumothorax was expanded with a chest tube At 17 hours, another ECG was recorded: It is now much less dramatic and has the morphology of Type 2 Brugada The hs troponin I peaked at 6500 ng/L -- this strongly suggests myocardial contusion. An echocardiogram was done. Is there also Brugada? Right ventricular prominence.
His medical history is unremarkable except a similar pain occurred 4-5 times in the previous 3 months with less intensity, short duration, unrelated to exertion. He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. He has 40 packs-year of smoking history.
He has never had any chestpain. Echocardiogram is indicated (Correct) C. Start aspirin and Plavix Correct answer: (B) (B) Echocardiogram is indicated. On the other hand, the murmur in valvular aortic stenosis does not change substantially or decreases slightly following the Valsalva maneuver.
A man in his 60's presented after 4 days of chestpain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. An echocardiogram showed no hemopericardium, but D oppler showed a new small ventricular septal defect with left to right shunting. There was some SOB.
Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Check : [vitals, SOB, ChestPain, Ultrasound] If the patient has Abdominal Pain, ChestPain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope).
A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chestpain and shortness of breath. She awoke in the morning with sharp chestpain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.
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