Retrosternal chest pain at a patient with diabetes mellitus and hypertension
April 18, 2010
| Abstract Title: | Retrosternal chest pain at a patient with diabetes mellitus and hypertension |
| Authors: | Ilie Oana-Maria, Corina-Eugenia Zorila, Veronica Grec |
| Affiliation: | “Vasile Goldis” Western University of Arad, Romania |
| Abstract text: | A 60-year-old man with a history of diabetes mellitus and hypertension presents to the emergency department 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 any deep breathing, but it is relieved by bending forward. He denies having any shortness of breath or palpitations. The patient has a past medical history of hypertension, diabetes, hypercholesterolemia, and adenocarcinoma of the prostate. In addition, the day before the symptoms occurred, the patient was diagnosed with costochondritis during a visit to his family doctor. The review of his systems is only significant for a recent respiratory infection that had improved approximately 2 weeks before presentation. The typical history for a patient with acute pericarditis consists of chest pain that is sudden in onset and pleuritic in nature. It is usually more intense when the patient is supine and improves when he or she sits upright and leans forward. The pain often radiates to the neck, upper arm, or shoulder as referred pain from the phrenic nerve’s course over the pericardium. The physical examination may reveal a high-pitched scratchy or squeaky friction rub best heard at the left sternal border at end expiration when the patient is leaning forward. Since pericardial friction rubs often vary in intensity from minute to minute, patients who have suspected pericarditis should have cardiac auscultation repeated multiple times. The friction rub is classically described as having three components, which correspond to atrial systole, ventricular systole, and rapid ventricular filling during early diastole; however, all phases may not be discernible in all patients. A pericardial friction rub can be distinguished from a pleural rub by the fact that it can be heard even when respirations are suspended. |
| Keywords: | diabetes mellitus, hypertension |
| Presentation type: | Poster |
| Correspondence: | no. 1 Feleacului St., Arad, Romania |
| Email: | oana_st17@yahoo.co.uk |
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