Bazan, Hernan A.; Morrissey, Nicholas J.; Hollier, Larry H.
A 72-year-old white male presented to his primary-care physician with a history of left chest pain for the past month. The pain was dull and constant and radiated to the back, medial to the scapula. He denied a new cough or worsening shortness of breath. He had no recent weight loss, and his appetite was good. He had a history of hypertension, which was currently controlled medically, and a significant 60 pack-a-year smoking history. In addition, he suffered a myocardial infarction (MI) 5 years ago. The patient denied any history of claudication, transient ischaemic attacks or stroke. He had undergone surgery in the past for bilateral inguinal hernias, and underwent cardiac catheterization after his MI.; On physical examination, the patient was thin but did not appear malnourished.; Vital signs were heart rate 72 beats/min, blood pressure 140/80 mmHg, respiratory rate 18/min, and temperature 36.8 degrees C. His head and neck examination was remarkable for bilateral carotid bruits. Cardiac examination revealed a regular rate and rhythm without murmurs. Abdominal examination revealed no bruits and a palpable aortic mass. His femoral and popliteal pulses were normal (2+); Posterior tibial pulses were 1+ bilaterally, and dorsalis pedis signals were detectable only by Doppler. No prominent popliteal pulses were appreciated. Routine blood work was unremarkable, and an electrocardiogram (ECG) revealed changes consistent with an old inferior wall MI and left ventricular (LV) hypertrophy. Chest X-ray (Fig. 5.1) was remarkable for a tortuous aorta, which had calcification within the wall and appeared dilated. There were no pleural effusions, but both hemidiaphragms did demonstrate some flattening, and bony structures were normal. Lung fields were clear of masses or consolidation.