QUESTION: Based on the Pt\'s history and vitals, can you please Give me Three po
ID: 269012 • Letter: Q
Question
QUESTION: Based on the Pt's history and vitals, can you please Give me Three possible diagnoses?
And what are the pathophysiology of each of the differential diagnoses?
Lastly, suggestion of what extra laboratory/diagnostic tests needed to come to a more definite diagnosis for this patient?
THANK YOU!!!!!
Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Emergency Department. On admission, Peter is sweaty, clammy, nauseated and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter's first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20-30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Physical exam A middle age obese male, clutching to his chest and appears to be nervous and in pain. . Respiratory rate: 18 breaths per minute (normal 12-20 x/minute) . Blood pressure: 150/90 mmHg (normal: 120/80 mmHg) . Heart rate: 105 beats per minute (normal 60-100 x/minute) Lung: clear to auscultation. .Temperature: 37°C. (normal: 36.10-37.2Explanation / Answer
1. Acute Myocardial Infarction ( Pathophysiology: The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an artery supplying heart muscle. when plaque rupture it will block supply to coronary arteries leading to Ischemia (cell death) of Heart muscles. Obese, smoking..etc are risk factors for MI)
2. Acute Aortic Dissection (In an aortic dissection, blood penetrates the intima and enters the media layer. The high pressure rips the tissue of the media apart along the laminated plane splitting the inner two-thirds and the outer one-third of the media apart. This can propagate along the length of the aorta for a variable distance forward or backwards. Dissections that propagate towards the iliac bifurcation (with the flow of blood) are called anterograde dissections and those that propagate towards the aortic root (opposite of the flow of blood) are called retrograde dissections.)
3. Acute Pericarditis (Pericardial effusion is a collection of fluid in the pericardial sac. This fluid may be produced by inflammation. The cause of pericarditis in most individuals is unknown but is likely due to viral infection. Pericarditis may be an associated complication of many diseases or may be due to trauma.)
Cardiac Biomarkers should be ordered to ruleout MI. EKG changes are significant in MI & Pericarditis. CT/MRI should be ordered to rule out Aortic Dissection. Cardiac echography also helpful.