This guy comes in to the ER with chest pain and you won’t believe what happens
Full cardiac workup plus full PMH and PSH. Trop and 2hr trop negative. EKGs show NSR. Turns out they have an inherited disorder that predisposes them to develop blood clots. They take Coumadin, or rather they’re supposed to take it. The significant other rats then out and says the patient stopped taking it.
So naturally they get a CT scan and guess what? Go ahead. You’ll never guess.
The scan reveals a dissected aortic aneurysm. DISSECTED. AORTIC. ANEURYSM.
Oh. But it gets better. Name two things that don’t go well together. Here, I’ll help: dissected aortic aneurysm and Coumadin. Yeah. Bad. Not good. But remember, this patient stopped taking their Coumadin.
I know what you’re thinking: how is this patient living if their aorta dissected? A clot. This patient had a massive clot sitting at the dissected section of the aorta, preventing them from bleeding out.
And they wanted to go home and follow up with their cardiologist on Monday. To which I replied…
We don’t have cardio-thoracic coverage, so we ended up transferring this patient. But, damn, what a hell of a case.
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