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Chest pain so bad you're afraid you're going to live (as opposed to chest pain so bad you're afraid you're going to die)
    Differential Diagnosis[Top] [Nav]
pain of aortic dissection (as opposed to the pain of myocardial infarction)
    Discussion -- not available online[Top] [Nav]
    Erratum in printed version[Top] [Nav]
       *[footnote 1] The wrong person was cited in the first printing.
    Update Comments[Top] [Nav]
  • "Not uncommonly patients will try to dissipate the pain [of aortic dissection] by moving about, as opposed to patients with angina who more often try to remain motionless." [101]
  • "A catastrophic onset of pain, migratory pain, and peculiar sites of discomfort are frequent features of aortic dissection." [102]
  • Ingestion of sweet peas (Lathyrus odoratus) or occupational exposure to dimethylhydrazine predispose to aortic dissection. [103]
  • "In only 2 of the 17 cases in which the pain originated in the chest was there any real semblance to the pain of myocardial infarction." [108]
    Footnotes in Print Edition[Top] [Nav]
    (1) Personal communication from Donald D. Trunkey MD, who heard it from a patient at the University of California (San Francisco), circa 1972.
[See erratum, below.]
    (2) Dissecting aneurysm of the aorta: a review of 505 cases.
  Hirst AE Jr, Johns VJ, Kime SW.   Medicine. 1958;37:217-279.
    (3) Aortic dissection.
  DeSanctis RW, Doroghazi RM, et al.   N Engl J Med 1987 Oct 22;317(17):1060-7.  Pubmed  Similars
    (4) Heart Disease. 3rd ed.
  Braunwald E, et al. Philadelphia: Saunders, 1988: 1235.   Amazon.com
    (5) Heart Disease. 3rd ed.
  Braunwald E, et al. Philadelphia: Saunders, 1988: 1555.   Amazon.com
    (-) Elevated serum creatine kinase levels. An early diagnostic sign of acute dissection of the aorta.
  Davidson E, Weinberger I, et al.   Arch Intern Med 1988 Oct;148(10):2184-6.  Pubmed+Abstract  Similars
    New References[Top] [Nav]
    101.Aortic Dissection.
  Doroghazi RM, Slater EE. New York: McGraw-Hill, 1983: 62.
    102.Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-1985. A 49-year-old man with a headache followed by collapse and rapid neurologic deterioration.
  N Engl J Med 1985 Jun 13;312(24):1560-7.  Pubmed  Similars
    103.The clinical recognition of dissecting aortic aneurysm.
  Slater EE, DeSanctis RW.   Am J Med 1976 May 10;60(5):625-33.  Pubmed+Abstract  Similars
    104.Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-1987. A 60-year-old man with facial swelling, cyanosis, and dilatation of the ascending aorta.
  N Engl J Med 1987 Jul 9;317(2):99-108.  Pubmed  Similars
    105.Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 39-1993. An 83-year-old woman with hypertension, sudden severe back pain, and anuria.
  N Engl J Med 1993 Sep 30;329(14):1028-33.  Pubmed  Similars
    106.The diagnosis of thoracic aortic dissection by noninvasive imaging procedures [see comments].
  Nienaber CA, von Kodolitsch Y, et al.   N Engl J Med 1993 Jan 7;328(1):1-9.  Pubmed+Abstract  Similars
    107.Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions [see comments].
  Cigarroa JE, Isselbacher EM, et al.   N Engl J Med 1993 Jan 7;328(1):35-43.  Pubmed  Similars
    108.Dissecting aneurysm of the aorta: its clinical, electrocardiographic and laboratory features.
  Levinson DC, et al.   Circulation. 1950;1:360-387.
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:34 PDT on July 4, 2000.[Top]

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