This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kim, M. H. Articles by Isselbacher, E. M. Search for Related Content PubMed PubMed Citation Articles by Kim, M. H. Articles by Isselbacher, E. M. Related Collections Cardiovascular imaging agents/Techniques Other etiology Other diagnostic testing CV surgery: aortic and vascular disease

(Circulation. 1999;100:e68-e72.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Bayesian Persuasion

Presented to Massachusetts General Hospital (E.M.I.) in written installments from July 1997 to April 1998.

Michael H. Kim, MD; Kim A. Eagle, MD; Eric M. Isselbacher, MD

From the Cardiovascular Division, University of Michigan Medical Center, Ann Arbor, Mich (M.H.K., K.A.E.), and Cardiovascular Division, Massachusetts General Hospital, Boston, Mass (E.M.I.).

Correspondence to Michael H. Kim, MD, Cardiovascular Division, University of Michigan Medical Center, B1F245, University Hospital, 1500 E Medical Center Dr, Ann Arbor, MI 48109.

Key Words: Clinicopathological Conferences • aorta • diagnosis • cardiac tamponade • aneurysm \ {texf}

	Case Presentation (Michael H. Kim, MD)

 
A 77-year-old woman was brought to a community hospital emergency room after an episode of syncope. She had been seated at the table and had passed out for 2 minutes. She had a history of hypertension, paroxysmal atrial fibrillation, and an abdominal aortic aneurysm repair 10 years earlier. She had no complaints immediately before the syncopal episode. When she awoke, she complained of mild chest and back discomfort that resolved quickly. Over the past several months, she had fatigue, malaise, and abdominal pain, and she had lost 10 lbs of weight. At the hospital, her systolic blood pressure was noted to be 47 mm Hg, and she was transferred to the University of Michigan Medical Center.

	Clinical Discussion (Eric M. Isselbacher, MD)

 
Although there are numerous causes of syncope, a careful history can often help narrow the differential diagnosis considerably. In this patient, syncope appears to have occurred without warning, and because the patient remained unconscious for 2 minutes, vasovagal syncope is not likely. Her chest and back pain immediately raises the suspicion of either acute myocardial infarction or aortic dissection. She has a history of both hypertension and an abdominal aortic aneurysm, so she is at risk for both coronary artery disease and aortic dissection. Her hypotension is consistent with either true cardiogenic shock or "pseudohypotension," a falsely low blood pressure measurement that may occur with aortic dissection. This finding is due to acute compromise of arterial flow to the subclavian artery. If she was awake and responding to questions when this blood pressure was . . . [Full Text of this Article]