01-31-2010, 12:33 AM
A 26 yr old primigravida at 20 week gestation presents to the ER with sudden onset of tearing cheast pain radiating to the back and left arm. The pt is pale and diaphoretic hee pylse is 116/min and bp is 190/100 in lft arm and 80/60 in rt arm. Cardiac exam reveals a distolic murmur along the lft sternal border. Her previous prenatal care is not knwn. She is a smoker with 10 yr hstory of smoking and drinks alcohol. Her ecg reveals mild lft axis deviation in leads II, III and avf. What is the most app next step in management of this pt
a. Obtain ck-MB and troponin levels
b. Transesophageal echo
c. Transthoracic eco
d. Anti hypertensive medication
e. CT scan of chest
f. Chest xray
a. Obtain ck-MB and troponin levels
b. Transesophageal echo
c. Transthoracic eco
d. Anti hypertensive medication
e. CT scan of chest
f. Chest xray