03-07-2010, 04:43 PM
A 72-year-old man is evaluated in the emergency department for the sudden onset of severe sharp anterior chest pain radiating into the back. He is a former smoker with a long history of type 2 diabetes mellitus, chronic renal insufficiency (creatinine 2.0 mg/dL [176.84 μmol/L]), sick sinus syndrome with a DDD pacemaker implanted in 1995, and hypertension. His medications include insulin, furosemide, ramipril, and aspirin.
On examination, the blood pressure is 185/85 mm Hg bilaterally, and the pulse rate is 90/min and regular. A grade 2/6 systolic murmur and a soft decrescendo diastolic murmur are heard at the second right intercostal space. There are abdominal and bilateral femoral bruits, with absent distal pulses.
Which of the following is the most appropriate initial imaging study?
A Non-contrast chest CT
B Chest MRI
C Transesophageal echocardiography
D Transthoracic echocardiography
On examination, the blood pressure is 185/85 mm Hg bilaterally, and the pulse rate is 90/min and regular. A grade 2/6 systolic murmur and a soft decrescendo diastolic murmur are heard at the second right intercostal space. There are abdominal and bilateral femoral bruits, with absent distal pulses.
Which of the following is the most appropriate initial imaging study?
A Non-contrast chest CT
B Chest MRI
C Transesophageal echocardiography
D Transthoracic echocardiography