Fast Five Quiz: Can You Recognize Subtle and Surprising Signs of Heart Conditions?

Yasmine S. Ali, MD, MSci

Disclosures

July 11, 2017

Unequal upper-extremity pulses can be suggestive of aortic dissection, which commonly presents with chest pain radiating to the back, accompanied by a blood pressure difference of 15 mm Hg or greater between both arms and an aortic regurgitation murmur.

Fever is usually present within 24-48 hours, with the temperature curve generally parallel to the time course of elevations of creatine kinase levels in the blood. Body temperature may occasionally exceed 102°F.

In general, the patient's blood pressure is initially elevated (hypertension because of peripheral arterial vasoconstriction resulting from an adrenergic response to pain, anxiety, and ventricular dysfunction). However, it is not uncommon to have increased blood pressure as the precipitant of acute MI. Alternatively, hypotension can also be seen. This usually indicates either right ventricular MI or severe LV dysfunction due to a large infarct area or impaired global cardiac contractility.

In patients with acute inferior-wall MI with right ventricular involvement, distention of neck veins is commonly described as a sign of failure of the right ventricle. Impaired right ventricular function also leads to systemic venous hypertension, edema, and hepatomegaly.

For more on the presentation of MI, read here.

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