Chief Complaint:-Aortic Dissection
Subjective: – Patient relates, ‘while I was preparing to attend church I began feeling a strong stabbing pain in my chest around the region of my heart. It was sudden and unbearable as if something was tearing away at my chest. Then it began radiating to my back and I began to feel as though I was fainting. It was then that I called 911.’
Objective: – Upon examination Mrs. R.G was cold and clammy semi-conscious. She responded to her name, but reflexes were limp. Blood pressure was 190/100; pulse 70; Respiration; 20; Heart beat 60 and Temperature 98.6 degree Fahrenheit. She could not speak during history taking, but the relative accompanying her related that she began having slurred speech before boarding the ambulance. By the time she arrived at the emergency she became comatosed (Adler, 2007).
Assessment: – During the HPI Mrs. R.G could not give verbal responses because the case presentation required emergency intervention. However, the accompanying relative indicated that Mrs. R.G was an executive of a large firm for 20 years. According to the identification tendered she is a 57 years old woman who had reached menopause.
There were neither visible abdominal scars nor breast abnormalities. Lung fields were clear, but tenderness evident around the mediastinum region. EKG readings did not suggest myocardial infarction or heart failure. Chest X-ray showed widening of the aorta and a marked difference between blood pressure readings in left and right arms. Computerized tomography (CT) scans; Magnetic resonance angiogram (MRA) and Transesophageal echocardiogram (TEE) validate an aortic dissection diagnosis (Shimony, 2011).
Plan: – Further assessment to prevent rupture of aorta.
Adler, M. (2007). The history of the present illness as treatment: who’s listening, and why does it matter? J Am Board Fam Pract, 10 (1), 28–35.
Shimony, A. Filion, B. Mottillo, S. Dourian, T. Eisenberg, M. (2011). Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. The American journal of cardiology, 107 (8), 1227–34