Question

A 68-year-old male is complaining of substernal chest pressure. The pressure is radiating to his left shoulder. This patient has no history of heart disease, diabetes, hypertension, or stroke. His father died from a heart attack at the age of 62. This patient is moderately anxious. He is not obese, and his vital signs are within normal limits except for a blood pressure of 90/48

What do you think this patient is experiencing? Why?

Answer 1

Substernal chest pressure radiating to left shoulder indicate the patient is having angina(classical presentation- patient complains of weight on chest or pain radiating to left shoulder inner side of left arm, neck, jaw).

Low Diastolic BP and increased pulse pressure along with angina point towards Aortic Regurgitation (AR).

Here there are not much of information available relating the onset of angina or previous similar episodes or any other associated symptoms like dyspnoea, palpitations, syncope,etc.

So, there are 2 possiblities:

1.If we assume that patient had such episodes previously with associated dyspnoea for a long time, this could be a case of Chronic AR.

2. If we assume that patient has only the symptoms mentioned in the question and this is his 1st episode then the diagnosis would be Acute AR following a MI.

Here positive family history of heart attack point more towards the diagnosis of "possibility 2".

Final diagnosis- Acute AR following MI.