Medical Challenge Case

Case: Hearts and Minds

S: Mrs. Wice, 65-years-old. She complains of chest pain for the past few days. She indicates that she uses chelation therapy and takes cayenne regularly. She indicates that she gets out of breath when she climbs stairs. She also complains that her back hurts. She reports a minor cold about one week ago. 

O: Patient has breast implants bilaterally. Sublingual nitroglycerin tablets did not relieve her pain. ECG results were normal, patient was positioned in various positions and was found that pain was somewhat relieved sitting up. Blood oxygen saturation was 90. Her systolic blood pressure was 80. Chest X-ray showed some fluid in her lungs. A follow-up chest X-ray confirmed that her lungs were getting worse. Blood chemistry revealed cardiac enzymes negative. Echocardiogram indicated that her ventricles were pumping out a lot of pressure. CT scan showed no signs of aortic dissection.

A: What is your diagnosis of this patient?

P: What is your recommended plan of treatment?