Aortic dissection and murmur

[bludeviled]

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this may be a moot point but QBank has a question as follows:

pt excrutiating pain in shoulder blades -radiates to back but not to arm. uncontrolled hypertension. new systolic murmur. blood pressure diff of 40 b/w both arms.

i picked aortic dissection (choice D) which is right answer but the systolic murmur is bothering me. wouldn't he get aortic regurg and hence a diastolic murmur? is there any way a dissection could produce a systolic murmur? thanks in advance

the explanation did not address the murmur other than to say:
"Valvular rupture (choiceA) could cause the new murmur but does not explain the pain or bp difference."

 

[Ramoray]

i would say that is justa typo , shoulda been diastolic but im no cariologist

 

[Idiopathic]

i picked aortic dissection (choice D) which is right answer but the systolic murmur is bothering me. wouldn't he get aortic regurg and hence a diastolic murmur? is there any way a dissection could produce a systolic murmur? thanks in advance

The answer is yes, an aortic dissection could cause a systolic murmur. If the dissection were tu push the outlet in any way, one could get a flow obstruction and a systolic murmur. I agree, a diastolic murmur is most likely, but aortic dissection is really the only explanation.

 

[Ramoray]

The answer is yes, an aortic dissection could cause a systolic murmur. If the dissection were tu push the outlet in any way, one could get a flow obstruction and a systolic murmur. I agree, a diastolic murmur is most likely, but aortic dissection is really the only explanation.

could you give me a source for this info? i looked this up in harrisons, uptodate and sabiston textbook of surgery, nowhere did i hear this mentioned. just curious as i am wondering why qbank would put that if it wasnt an error. Not that i dont believe you but for my own curiousity i am wondering why qbank woul be dickholes and say system and really mean to say system if it is an extradorinarly rare occurence

 

[idq1i]

Source for what?

Type A dissections distort the ascending aorta. In systole, this outflow obstruction sets up a turbulent flow pattern, which is detected as a systolic murmur

The AD can also dissect into the aortic root, resulting in functional insufficiency of the aortic valve. This would result in regurg/diastolic murmur

 

[Idiopathic]

Source for what?

Type A dissections distort the ascending aorta. In systole, this outflow obstruction sets up a turbulent flow pattern, which is detected as a systolic murmur

The AD can also dissect into the aortic root, resulting in functional insufficiency of the aortic valve. This would result in regurg/diastolic murmur

This is pretty much what I am saying. I have seen both cases and do not have a citation, but can imagine how either case occurs. It could very well be a typo, but it could also be an actual case.

 

[Ramoray]

*******( not you idio) a source means citing something instead of pulling it out of your ass like you usually do idi, i looked it up in probably the top three sources for medicine and nowhere does it mention that as a possibility so find me a source tool boy and then get back to me. thanks

 

[idq1i]

This is pretty much what I am saying. I have seen both cases and do not have a citation, but can imagine how either case occurs. It could very well be a typo, but it could also be an actual case.

/ramoray to the "ignore" list. Envious tool. Or just passive-aggressive?

Here's one citation: Rev Cardiovasc Med. 2003 Spring;4(2):112-6.

While this Qbank q stimulates intellectual discussion on SDN, I bet Kaplan screwed this question up