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Chest and Back Pain

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Abstract

A 26-year-old male presents to the emergency department complaining of sudden-onset severe chest pain radiating to the upper back for the past 3 h. He describes it as a tearing sensation in his back. He denies any fevers or chills but reports an episode of syncope prior to arriving to the hospital. He is unable to remain still secondary to pain. His past medical history is negative. On initial exam, his blood pressure is 140/50 mmHg, and heart rate is 102/min. He appears to be tall and thin, with long arms, long thin fingers, and hypermobile joints. His sternum has a concave deformity. Cardiac examination reveals a regular rhythm with an early diastolic murmur at the left upper sternal border and muffled heart sounds. Breath sounds are equal bilaterally without crackles. ECG demonstrates nonspecific ST-segment changes. Troponin and CK-MB are within normal ranges. A chest x-ray demonstrates a widened mediastinum (Fig. 9.1).

Keywords

  • Aortic dissection
  • Aortic regurgitation
  • Marfan’s
  • Ehlers-Danlos
  • DeBakey
  • Stanford

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Fig. 9.1
Fig. 9.2
Fig. 9.3
Fig. 9.4

Suggested Reading

  • Braverman AC. Acute aortic dissection clinician update. Circulation. 2010;122:184–8.

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  • Hiratzka LF, Bakris GL, Beckman JA, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–e129.

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Correspondence to Ryan Ou .

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Ou, R., Frank, P.N., Benharash, P. (2020). Chest and Back Pain. In: de Virgilio, C., Grigorian, A. (eds) Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-05387-1_9

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  • DOI: https://doi.org/10.1007/978-3-030-05387-1_9

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  • Publisher Name: Springer, Cham

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