Clinical Summary

A 35 year old Hispanic woman was brought to the ER because of acute chest pain and shortness of breath. Her medical history included hyperthyroidism treated for 4 years with PTU (propylthiouracil), tonsillectomy at 15 years of age, and cigarette smoking for the past 20 years. The patient described non-progressive dyspnea on exertion, and occasional episodes of chest pain and abdominal pain after each meal. She had not taken any medications recently. Upon arrival, her pulse was 120 ppm with diminished carotid and lower extremity pulses and absent pulses in the upper extremities. Her BP was 97/68 mmHg. There was central cyanosis. An ECG showed RBBB and ST elevation in the anterolateral leads. An arterial blood gas showed hypoxemia. The chest x ray was unremarkable (no cardiomegaly). Blood chemistries revealed slightly low albumin (normal total protein), calcium and uric acid; slightly elevated LDH, SGPT, CK, alkaline phosphatase and creatinine, and normal bilirubin and SGOT. The differential diagnoses included pulmonary embolism and myocardial ischemia. The patient suffered a cardiorespiratory arrest and despite prolonged resuscitative efforts was pronounced dead 3 hours after admission.

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