Ultrasound Case of the Week #14 (Thanks to Daniel Gilstrap and Dr. Taylor!)
Chief Complaint: “Chest pain”
"Don't startle this guy when you do his echo..." -Dr. Taylor
HPI: Pt. is a 46 year-old incarcerated male who presented with the chief complaint of chest tightness and diaphoresis for several days. His pain had initially improved with rest, but recurred intensely on the day of presentation. He noted no precipitating event. Pain is substernal, dull in quality and non-radiating; he also notes associated dizziness. The chest pain improved with nitroglycerin enroute. He denies any nausea, vomiting, back or abdominal pain or syncope. He admits to SOB on exertion.
Pt. reports that an echo performed approximately 1 week ago revealed an "abnormality", and he was placed on "blood thinners."
ROS: Positive for dyspnea on exertion and orthopnea for past several weeks, otherwise a complete ROS was negative
PMH: hypercholesterolemia, hypertension, and questionable heart failure
Meds: Coumadin, Coreg, spironolactone, enalapril, HCTZ, and prn nitroglycerin
SH: Incarcerated since 1989. Denies current drug, etoh, or tobacco use.
PE:
Vital Signs: Temp 97.4 Pulse 101 Respirations 14 BP 95/71
General: Teary eyed in mild acute distress due to chest discomfort
HEENT: PERRLA, anicteric, OP clear, 2 cm of JVD noted.
Lungs: Crackles in bases bilaterally, R>L, No wheezing or retractions.
Cardiovascular: Tachycardic, regular rhythm, No M/R/G
Gastrointestinal: benign
Musculoskeletal: No clubbing, cyanosis, or edema.
Neurological: AO X3, Strength 5/5 bilaterally.
Relevant Workup:
EKG: nonspecific anterolateral T-wave changes
1st set of cardiac enzymes negative
Chest x-ray showed cardiomegaly and pulmonary cephalization
BNP 409 pg/mL
INR 1.5
A curious resident and medical student proceeded with a bedside echo…
To the Echo!
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