A 79-year-old woman presents to you with complaints of a 10-minute episode of chest pain that was maximal and tearing at its onset. She also tells you it was accompanied by shortness of breath. The episode resolved while she was being transported to the emergency department (ED).
Her vital signs are: temperature 37.1 °C (98.8 °F), blood pressure 140/95 mm Hg, pulse rate 87 beats/minute, and respiration rate is 16/minute. Electrocardiography shows a mild right heart strain pattern with ST-T changes that may indicated ischemia; initial troponin level and D-dimer levels are both borderline.
You are uncertain about pursuing a cardiac ischemia vs pulmonary embolism vs aortic dissection work-up. Which of the following imaging studies should you consider in this situation?
- triple rule-out computed tomography (CT) angiogram to image the coronary arteries, pulmonary vasculature, and the aorta
- computed tomography (CT) angiogram of the aorta; if negative, then admission to the observation unit for serial electrocardiography (ECG) and biomarker testing
- ventilation/perfusion (V/Q) scan with aortic follow-through; if negative, then admission to the observation unit for serial electrocardiography (ECG) and biomarker testing
- coronary computed tomography (CT) angiogram, followed by ventilation/perfusion (V/Q) scan if CT findings are negative
This question appears in Med-Challenger Emergency Nurse Practitioner Exam Review with CME
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