Pls: most common cause of chest pain in pregnancy?

[JS67]

if the pt with ST elevation inferior leads in EKG, substernal chest discomfort lasting 45 min and physical exam result are all normal (Bp 102/60, P 86, RR 18, no edema, no JVD...in Q stem no any mentioned abt body Temp)

A Pericarditis
B Pulmonary embolus
C Costochondritis
D Gastroesophageal reflux
E Coronary artery dissection

C? others?

BTW, primary Tx for Symptomatic Acromegaly :
Octreotide or Surgery? I would pick up surgery but not sure abt symptomatic thing

any ideas?

Thanks

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[JS67]

Someone said it's GERD since just a 45min symptoms and without positive physicals, but what about ST elevation in inferioir leads in EKG? It's possible with that in GERD?

if the pt with ST elevation inferior leads in EKG, substernal chest discomfort lasting 45 min and physical exam result are all normal (Bp 102/60, P 86, RR 18, no edema, no JVD...in Q stem no any mentioned abt body Temp)

A Pericarditis
B Pulmonary embolus
C Costochondritis
D Gastroesophageal reflux
E Coronary artery dissection

C? others?

BTW, primary Tx for Symptomatic Acromegaly :
Octreotide or Surgery? I would pick up surgery but not sure abt symptomatic thing

any ideas?

Thanks

 

[MacchinaDaCaffe]

if the pt with ST elevation inferior leads in EKG, substernal chest discomfort lasting 45 min and physical exam result are all normal (Bp 102/60, P 86, RR 18, no edema, no JVD...in Q stem no any mentioned abt body Temp)

A Pericarditis
B Pulmonary embolus
C Costochondritis
D Gastroesophageal reflux
E Coronary artery dissection

C? others?

BTW, primary Tx for Symptomatic Acromegaly :
Octreotide or Surgery? I would pick up surgery but not sure abt symptomatic thing

any ideas?

Thanks

Are you asking the most common cause of chest pain in pregnancy or the most likely diagnosis in this case? I would say that the most common cause of chest pain in pregnancy is likely GERD, or possibly costochondritis. However, in this case I would be concerned about a coronary artery dissection due to her EKG findings and the fact that she has persistent substernal chest pain which all points to a cardiac origin. Pericarditis is less likely (would show diffuse ST elevations, chest discomfort would improve with leaning forward, possibly would hear pericardial friction rub) and pulmonary embolism is also less likely (no tachycardia, or other Wells criteria type risk factors).

 

[JS67]

Sorry for the confusing title. With this pt, croronary A dissection is less likely, I guess, because there is no risk factor, such as high Bp.... I just discussed with someone and the most possibility may be still GERD?! Now the remaining q is incr progesterone in pregnancy can make vessel constriction, like angina?

Are you asking the most common cause of chest pain in pregnancy or the most likely diagnosis in this case? I would say that the most common cause of chest pain in pregnancy is likely GERD, or possibly costochondritis. However, in this case I would be concerned about a coronary artery dissection due to her EKG findings and the fact that she has persistent substernal chest pain which all points to a cardiac origin. Pericarditis is less likely (would show diffuse ST elevations, chest discomfort would improve with leaning forward, possibly would hear pericardial friction rub) and pulmonary embolism is also less likely (no tachycardia, or other Wells criteria type risk factors).

 

[spicedmanna]

Someone said it's GERD since just a 45min symptoms and without positive physicals, but what about ST elevation in inferioir leads in EKG? It's possible with that in GERD?

The pt is presenting with substernal chest discomfort and has STE in the inferior leads. Given this presentation, STEMI would have been the highest on my differential. To me, it would be an MI until proven otherwise (I'd get serial CKMB and Troponin's). Now, given the option list in the question, I would probably choose coronary artery dissection as the cause of this pt's presentation. It's not a very common cause (most common cause of AMI is going to be coronary artery thrombosis secondary to atherosclerosis), but coronary artery dissection can present with unstable angina and cause AMI (1). In this case, it could be a RCA dissection.

I don't get why you are bringing up the most common cause of chest pain in a pregnant woman? What does that have to do with this question stem? Your title and your question stem seem unrelated. Please clarify.

Also, keep in mind that SDN is not for homework help. However, given that it's Christmas and all...

 

[Doctor4Life1769]

I agree with the others. I was going to answer, then noticed a discrepancy and opted not to say anything. The most common overall is probably GERD due to estrogen and progesterone relaxing the LES causing reflux. I believe you also have decreased gastric emptying.

This is an abnormal EKG, which most likely is going to be cardiac in nature. I won't delve into what the others have already elaborated regarding this.

 

[Doctor4Life1769]

Sorry for the confusing title. With this pt, croronary A dissection is less likely, I guess, because there is no risk factor, such as high Bp.... I just discussed with someone and the most possibility may be still GERD?! Now the remaining q is incr progesterone in pregnancy can make vessel constriction, like angina?

Vessel constriction? Isn't it vasodilation, which leads to decreased SVR and BP, hence an increase in HR, SV, and CO to compensate? Hence the systolic flow murmur ...

 

[Frugal Traveler]

if the pt with ST elevation inferior leads in EKG, substernal chest discomfort lasting 45 min and physical exam result are all normal (Bp 102/60, P 86, RR 18, no edema, no JVD...in Q stem no any mentioned abt body Temp)

A Pericarditis
B Pulmonary embolus
C Costochondritis
D Gastroesophageal reflux
E Coronary artery dissection

C? others?

BTW, primary Tx for Symptomatic Acromegaly :
Octreotide or Surgery? I would pick up surgery but not sure abt symptomatic thing

any ideas?

Thanks

If this is a MKSAP 14 question, perhaps E (there are numerous case reports about spontaneous coronary artery dissection during pregnancy

For acromegaly, see http://endocrine.niddk.nih.gov/pubs/acro/acro.htm#treatment

This is a tough question without further details.

Would favor surgery as well.