Case

A 41-year-old man presents to the emergency department (ED) complaining of a severe frontal headache that began suddenly and awakened him from sleep. The headache is associated with nausea, vomiting, and subjective fevers. He also complains of new-onset diplopia and photophobia, but denies any decrease in visual acuity. He denies experiencing any associated seizures, اقرأ المزيد لهذه المشاركة
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Answer to Case of the Week 001

Answer is Proximal Aortic Dissection

“The Author states that during this period he has been unable to “get comfortable”. The intensity of the pain increases during inspiration and with body movement.”

“He has no reported history of hypertension, coronary artery disease, prior cardiac surgery, diabetes mellitus, or hyperlipidemia.”
….No risk factors of AMI

“He is afebrile. His blood pressure is 160/102 mm Hg”
… HTN is Risk Factor of Aortic Dissection

“pulse is 103 bpm and regular.”
No Tachycardia so NO PERICARDITIS

“he cardiac examination reveals an early diastolic murmur in the aortic region, with no gallop, pericardial rub, or knock;”
No Rub so no pericarditis

“Serial cardiac isoenzyme tests demonstrate no evidence of myocardial injury.”
so sure is not AMI

ECG shows Pericarditis Pattern

The clinical picture of sudden Tearing like Pain in chest suggestive of Aortic Dissection
Patient with Acute Myocardial Infarction will suffer of heaving pain and will have history of Anginal pain
Pericarditis will have Fever and Tachycardia

so it’s Proximal Aortic Dissection

if you have another answer or comment pls tell on comments below

Case of the week 001

A 42-year-old man presents to the hospital with dull, anterior precordial and retrosternal chest pain that began acutely with a tearing sensation and has lasted for 3 days. He states that during this period he has been unable to “get comfortable”. The intensity of the pain increases during inspiration and with body movement. The patient denies any symptoms of recent viral infection, and he has received no recent vaccinations. He has no reported history of hypertension, coronary artery disease, prior cardiac surgery, diabetes mellitus, or hyperlipidemia. He has no family history of cardiovascular disease. The patient is taking no prescribed medication, over-the-counter medication, or herbal remedies, and he denies illicit drug use.

The patient is alert but appears uncomfortable. He is afebrile. His blood pressure is 160/102 mm Hg in all extremities, with equal and symmetric pulses in both carotid and brachial arteries. His pulse is 103 bpm and regular. The cardiac examination reveals an early diastolic murmur in the aortic region, with no gallop, pericardial rub, or knock; however, the heart sounds are slightly distant. The patient’s lungs are clear to auscultation. The abdominal findings are unremarkable. The patient’s cranial nerves are intact, and no neurologic deficits are noted.

An electrocardiogram (ECG) is obtained. Serial cardiac isoenzyme tests demonstrate no evidence of myocardial injury.