A 59-year-old man has crushing retrosternal chest pain and shortness of breath that is exaggerated by walking. He has uncontrolled T2DM. On examination: His HR130/min, respiratory rate is 45/min and BP in the right arm is 190/100 mmHg and the left arm is 130/84 mmHg. His pulse oximetry reveals a saturation of 94%. He has a diastolic decrescendo murmur at the 3rd and 4th left parasternal area. ECG shows ST elevation in anterior leads suggesting myocardial infarction. Troponin1 is highly positive. What is the most likely diagnosis?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: C. Aortic Dissection
A 60 mmHg inter-arm BP difference, a new decrescendo diastolic murmur (acute aortic regurgitation), and ST elevation with raised troponin (dissection extending into a coronary ostium) = type A aortic dissection. An MI/unstable angina alone would not explain the BP asymmetry and AR murmur. Don't thrombolyse.
ليش كل خيار صح أو غلط
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A
ليش غلط
Pericarditis gives pleuritic, positional pain (worse supine, better leaning forward) with a friction rub. It does not explain a 60 mmHg arm-to-arm BP gap or a new diastolic murmur.
✓ 7• Pericardial Diseases [Notes].pdf · p. 3 -
B
ليش غلط
Unstable angina means ischemia without infarction: no ST elevation and negative troponin. This patient has ST elevation and a highly positive troponin, which is a transmural infarct picture instead.
✓ (Y4)-(M B) Ischemic Heart and Acute coronary syndrome.pdf · p. 8 -
C
ليش صح
Asymmetrical limb BPs (190 vs 130 mmHg between arms) and an aortic regurgitation murmur (diastolic decrescendo) are classic signs of a proximal dissection.
✓ Dr. Al-Ahmadi - Dyslipidemia and Aortic Dissection✅.pdf · p. 7 -
D
ليش غلط
PE causes pleuritic chest pain and dyspnea from pulmonary artery occlusion and impaired gas exchange. It does not cause a BP difference between arms or a diastolic murmur.
✓ 12• Venous Thromboembolism [Notes].pdf · p. 3
- المصدر
- 10• Aortic Diseases [Notes].pdf · p. 3
Dr. Al-Ahmadi - Dyslipidemia and Aortic Dissection✅.pdf · p. 8
Dr. Al-Ahmadi - Dyslipidemia and Aortic Dissection✅.pdf · p. 7 - المحاضرة
- Hypertensive Crisis & Aortic Dissection · Cardiology · Module B
- ظهر في
- Cardio bank