37yo CP

[Bjs04f]

37yo F present at 4pm to your ED. Pt has had chest pain since 11am, beginning at rest, sharp, non radiaitng, no aggrev or allev factors. Pain is 6/10, no similar episodes. Pt has no shortness of breath or other complaints. Pt has history of horsehoe kidney, and congenital bicuspid aortic valve. pt on no meds with no surgies, does not smoke. Pt has no fam history. Vitals P95, BP 150/89, temp 98.5, NAD. Go

[tyson]

start w/ ekg, chest x-ray.

might move to CTA r/o dissection w/ HTN, tachycardia and consistent chest pain, especially w/ risk factors.

have studies to show us?

[Bjs04f]

EKG normal sinus rhythm. CXR unremarkable. CBC, BMP, Cardiac panel negative. Why a CTA and what risk factors are you looking at

[tyson]

she sounds like potential turner's syndrome patient, i initially wanted CTA to rule out disection, but likely you'll be finding coarctation of aorta. an echo would be a decent choice too if you want to look at left ventricular size and squeeze and evaluate flow of blood through the bicuspid aortic valve.

did you do bedside U/S?

[Bjs04f]

Nope doesnt have turners syndrome, interesting thought though. Going with initial comment a CTA was done for PE. Pt has a dissection involving the ascending, arch, descending, abdominal aorta, the L subclavian and L common carotid. Pt was started on labetalol drip and nitro, went to CT surgery. Incredibly severe dissection for such little symptoms, especially with multiple normal physical exams, and the pt was never in acute distress.