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quiz
A 22-year-old clerical worker presented to the Emergency Department complaining of severe chest pain.
The pain started suddenly while sitting at his desk in work. He described the pain as being located in the centre of his chest, radiating directly backwards through to his back between the shoulder blades. The pain was not exacerbated by deep inspiration or by position and was not associated with dyspnoea. He had been known to have a heart murmur since childhood but was not under regular follow-up for this.
He lived with his mother and worked in a sedentary job in an office. His father had died while he was a child of a 'heart problem'.
On examination he was anxious and clearly in pain. He weighed 65 kg and was 2 metres tall. His pulse was 120 beats per minute with blood pressure 160/55 mmHg. The heart sounds were normal with a soft diastolic murmur audible at the lower left sternal border, heard loudest on sitting forward.
What is the most likely cause for his chest pain?
(Please select 1 option)
1-Acute myocardial infarction
2-Aortic dissection
3-Mitral valve prolapse syndrome
4-Pulmonary embolus (PE)
5-Spontaneous pneumothorax
The pain started suddenly while sitting at his desk in work. He described the pain as being located in the centre of his chest, radiating directly backwards through to his back between the shoulder blades. The pain was not exacerbated by deep inspiration or by position and was not associated with dyspnoea. He had been known to have a heart murmur since childhood but was not under regular follow-up for this.
He lived with his mother and worked in a sedentary job in an office. His father had died while he was a child of a 'heart problem'.
On examination he was anxious and clearly in pain. He weighed 65 kg and was 2 metres tall. His pulse was 120 beats per minute with blood pressure 160/55 mmHg. The heart sounds were normal with a soft diastolic murmur audible at the lower left sternal border, heard loudest on sitting forward.
What is the most likely cause for his chest pain?
(Please select 1 option)
1-Acute myocardial infarction
2-Aortic dissection
3-Mitral valve prolapse syndrome
4-Pulmonary embolus (PE)
5-Spontaneous pneumothorax
Views: 9
Comment
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Comment by DR.BASIL SHAMMA on April 18, 2011 at 5:47pm -
excellent thank you very much
The patient is male and tall with a known heart murmur and a family history of cardiac disease-related death.
He has Marfan's syndrome with aortic regurgitation and aortic dissection. Salient features include the history of pain radiating through to the back, diastolic heart murmur and wide pulse pressure.
He is young with no preceding history of exertional chest pain. Premature ischaemic heart disease should be considered, but the character of the pain is atypical (radiating through to the back) and there is not a rational link to the heart murmur.
Mitral valve prolapse (MVP) syndrome encompasses numerous clinical symptoms that are commonly described by patients with MVP:
• chest pain
• fatigue
• palpitations
• light-headedness
• dizziness
• shortness of breath
• anxiety and/or panic attacks
• headaches
• low exercise tolerance.
There is no history of pleuritic chest pain to suggest a pulmonary embolus; PE would not explain the other findings.
Spontaneous pneumothorax is a risk in tall young men, but primarily presents with dyspnoea in addition to chest pain.
Pneumothorax and pneumomediastinum may both be associated with praecordial sounds: in pneumothoraces a distinct 'click' may be heard that is synchronous with the pulse; in pneumomediastinum the sound is better described as a 'crunch'.
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Comment by maged al ali on April 18, 2011 at 4:22pm -
2-aortic dissection
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