Cardiology Case Challenge: Worsening Chest Pain After a Respiratory Infection in a Man With Hypertension Show
Editor's Note: BackgroundA 60-year-old man with a history of diabetes mellitus and hypertension presents with a 1-day history of retrosternal chest pain. The chest pain began while he had been resting and continued to worsen over the next few hours. He describes it as a sharp pain that is moderate in intensity, with radiation to his right shoulder and neck. The pain worsens when he is lying down and with deep breathing, but it is relieved by bending forward. He denies having shortness of breath or palpitations. The patient has a medical history of hypertension, diabetes, hypercholesterolemia, and adenocarcinoma of the prostate. In addition, the day before the symptoms occurred, he was diagnosed with costochondritis during a visit to his family doctor. Review of his systems is significant only for a recent respiratory infection that had improved approximately 2 weeks before presentation. His medications include enalapril, hydrochlorothiazide, metformin, and a statin. He has smoked one pack of cigarettes a day for the past 20 years. The patient's family history is significant for premature coronary artery disease in two of his brothers.
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WebMD, LLC Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Cite this: Cardiology Case Challenge: Worsening Chest Pain After a Respiratory Infection in a Man With Hypertension - Medscape - Mar 24, 2022. Authors and DisclosuresAuthorsAbhimanyu Beri, MDResident Physician, Department of Internal Medicine, Michigan State University, Michigan Disclosure: Abhimanyu Beri, MD, has disclosed no relevant financial relationships. Fadi Abu-Yasin, MDAssistant Professor, Department of Internal Medicine, Michigan State University, Michigan Disclosure: Fadi Abu-Yasin, MD, has disclosed no relevant financial relationships. Need a Curbside Consult? Share cases and questions with Physicians on Medscape Consult. Share a Case close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel A 66-Year-Old Man With Shortness of Breath: USMLE Study QuestionMay 15, 2020 This patient's presentation and imaging are most consistent with decompensated heart failure. Chest radiography reveals cardiomegaly and prominent pulmonary vasculature. These findings, suggestive of pulmonary edema, support the diagnosis of heart failure. Initially, left ventricular dysfunction manifests with lateral displacement of the point of maximal impulse (PMI) and possible S3 gallop. Ultimately, left ventricular failure leads to congestion of the pulmonary vasculature and respiratory symptoms. Pulmonary edema can cause tachypnea, dyspnea, and crackles (heard at the lung bases initially and throughout all lung fields in severe cases). Pitting edema of the lower extremities is also a common finding. This patient is at increased risk for acute decompensation, due to stopping his diuretic medication. Major Takeaway: Heart failure due to left ventricular dysfunction can cause pulmonary edema, leading to dyspnea and tachypnea. Imaging studies may reveal cardiomegaly and prominent pulmonary vasculature. Read more about heart failure. Osmosis © 2020 Osmosis Need a Curbside Consult? Share cases and questions with Physicians on Medscape Consult. Share a Case Your Name is required. Subject is required. Please enter a Recipient Address and/or check the Send me a copy checkbox. Your email has been sent. is an Invalid Email Address. Abstract
Image 1 CT scan of the abdomen Full size image
Table 1 MIC susceptibilities Full size table
Image 2 ICP waveform tracing Full size image
Image 3 Bedside lung ultrasonography Full size image
Image 4 X-ray of the chest Full size image
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Rights and permissionsCopyright information© 2017 Springer International Publishing AG About this chapterCite this chapterLevy, Z.D. (2017). Exam 1 Questions. In: Levy, Z. (eds) Absolute Neurocritical Care Review. Springer, Cham. https://doi.org/10.1007/978-3-319-64632-9_1 Download citation
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