Melissa Bauman, CRNP
Lehigh Valley Physician Group Family Medicine–Bath
A 33-year-old patient with two small children went to their primary care provider for a routine physical. The patient had no past medical history and his family history was positive only for his father who died suddenly at 62 of unknown cause. The provider, Melissa Bauman, heard a heart murmur during the exam. The patient denied any exercise endurance issues and was asymptomatic of any cardiac disease, and the rest of the exam was normal. Bauman ordered him to have a 2D echocardiogram anyway, and the patient went for the study four days later. The technician noted a possible aortic dissection and notified the provider. The patient was taken immediately to the emergency department for a computed tomography angiography of the chest; the aortic dissection was confirmed as chronic type A dissection involving the aortic root, which was markedly dilated.
Given the high and sudden mortality this diagnosis can bring, the patient agreed to inpatient admission and surgical repair of his aortic dissection. The patient had cardiothoracic surgery and aortic root replacement, and was discharged home three days later. He since has quit smoking and is doing quite well. His cardiologist credits Bauman for saving the patient's life by noting the murmur and insisting on follow-up diagnostics, particularly considering the time-limited nature of office visits and this patient's lack of supporting symptoms.
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