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Case 104

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A 72-year-old male presented to an emergency unit with a 3-month constant thoracic and upper back pain of moderate intensity. He had history of hypertension, chronic obstructive pulmonary disease and smoking. Findings on examination included: BP (right-arm): 112/61mmHg; BP (left-arm): 126/59mmHg; HR: 63 bpm; RR: 20 irpm; normal heart sounds with a grade II/VI diastolic murmur at aortic area.

Which of the following findings IS NOT observed in the image herein provided?

a) Ascending aortic enlargement

25%

b) Aortic regurgitation

25%

c) Ascending aortic dissection

25%

d) Aortic stenosis

25%
   

Comments

- Clinical manifestations of aortic dissection might include sudden tearing chest or abdominal pain, asymmetric pulse and/or blood pressure (>20mmHg between left and right arms) and diastolic murmur of aortic regurgitation.

- An aortic dissection might lead to acute myocardial infarction (AMI), cerebrovascular accident (CVA) and congestive heart failure (CHF).

- Risk factors for aortic dissection comprise: arterial hypertension, atherosclerosis, congenital heart diseases and collagen-related disorders

- Imaging studies of choice for evaluation of suspected ascending aortic dissection include transesophageal echocardiography, computed tomography and magnetic resonance imaging.

- Aortic dissection might be described according to both DeBakey and Stanford classifications. We present the case of a Stanford type A/DeBakey type II aortic dissection.

- Ascending aortic dissection might lead to aortic regurgitation due to aortic leaflet prolapse or incomplete leaflet closure.

- Aortic stenosis might be congenital or acquired. Causes of acquired aortic stenosis include rheumatic heart disease and degenerative (age related) disorders.

References

Woo YJ, Molher ER. Clinical features and diagnosis of thoracic aortic aneurysm. In: Basow DS. UpToDate. Waltham: UpToDate; 2012.

Manning, WJ. Clinical manifestations and diagnosis of aortic dissection. In: Basow DS. UpToDate. Waltham: UpToDate; 2012.

Otto, CM. Clinical features and evaluation of aortic stenosis in adults. In: Basow DS. UpToDate. Waltham: UpToDate; 2012.

Author

Raphael Rabelo de Mello Penholati; 5th year medical student of UFMG School of Medicine.

E-mail: rapharmp[at]gmail.com

Supervisor

Dr. Gláucia Cristina Silva; Coronary care unit (CCU) cardiologist at Hospital das Clínicas in Belo Horizonte, Brazil.

E-mail: crismedhc[at]yahoo.com.br

Reviewers

Renato Campanati e Marina Leão

Translated by

Lucas Resende Lucinda, 6th year medical student of UFMG School of Medicine.
E-mail: lucasresendebh[at]hotmail.com

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