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forerofore
there is another clue, the man has diminished pulses in just one arm, which means that the left subclavian artery must be involved somehow, and an aortic dissection would be the best answer explaining this.
+11
temmy
please why is there where a diastolic mumur?
+1
whoissaad
@temmy Aortic dissection especially near the root of aorta can lead to dilatation of the aortic valves, which can lead to Aortic regurgitation (diastoic murmur at left sternal border)
+9
garibay92
Does anyone know why is this patient's tepmerature elevated?
+1
ratadecalle
@garibay92, not important for this question I think but cocaine can cause malignant hyperthermia
+2
almondbreeze
judging by his heart murmur, he probably has marfan syndrome. that's the only place where FA talks about dissecting aneurysm
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turtlepenlight
did anyone else think it was weird his only sx was SOB? I always think of radiating pain as being a good clue for dissection
+3
cmun777
@almondbreeze his heart murmur is at the LSB (aortic regurg) and not consistent with MVP plus no other sx/indication of Marfan. I think the only association of RF you should think about in this question is the cocaine use and consequent HTN.
+1
ibestalkinyo
@turtlepenlight I agree. I chose another answer because I was like, there's no way this guy doesn't hurt if he's got a dissection.
+1
abk93
@whoissaad
but aortic regurgitation is a systolic murmur.
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calvin_and_hobbes
My guess is that the diastolic murmur is tricuspid stenosis as the tricuspid valve is the most common valve affected in patients who have IVDU
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readit
*same goes for saccular aneurysm, which also is usually 2/2 trauma
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samsam3711
In the question stem there is no indication of trauma so it would be hard to just assume that
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almondbreeze
see my comment above for marfan syndrome. might help
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drzed
This is because a pseudoaneurysm is between the media and adventitia, and is incited by trauma; a dissection is between the intima and the media and is a result of hypertension causing an intimal tear. The history points toward cocaine -> hypertension rather than penetrating trauma.
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submitted by โneonem(630)
Major risk factor for aortic dissection is hypertension, and in this case might be due to cocaine use, which causes marked hypertension. Dissections cause a tear in the tunica intima -- blood can flow backwards into the pericardium and cause tamponade. This manifests as crackles in the lung due to poor left ventricular function (filling/diastolic problem due to compression).