An 86-year-old man presented in the Emergency Room with a chief complaint of dull abdominal pain radiating to both flanks. He had been treated for hypertension for 25 years and at the time of admission he was taking propranolol 40 mg twice daily, hydrochlorothiazide 25 mg on alternate days, and alphamethyldopa 250 mg daily.
The patient reported chest pain on climbing one flight of stairs, relieved promptly by sublingual nitroglycerin. Although the patient had been informed that he had hyperglycemia, he was not on any medication to control his blood sugar. He had been admitted to the hospital 6 months earlier with a transient ischemic attack that resolved without evidence of neurologic deficit.
Blood pressure was 160/100 mmHg, pulse 86/min and regular laboratory findings were as follows: hematocrit 31%, hemoglobin 10.2 gm, white blood cell count 9700/mm3; serum electrolytes—potassium 3.0 mEq/l, sodium 135 mEq/l, chloride 101/mEq/l; blood glucose 225 mg/dl, BUN 50 mg, creatinine, 2.0 mg. The electrocardiogram showed normal sinus rhythm, with evidence of an old inferior wall infarct. Chest x-ray showed evidence of bilateral basal congestion and mild congestive heart failure.
A diagnosis of abdominal aortic aneurysm was confirmed by ultrasound and CT scan. The patient was scheduled for repair of the aneurysm on a semiemergent basis.
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