Follow up on Neck Pain questions of 8/6/01

[kd]

I wrote on 8/6/01 about neck and chest pain. Hx: PVD, stroke, severe MVPR, absent L Common Carotid, atherosclerosis obliterans, high systolic BP, IVP dye allergy. Went to the ER on 8/7 and was held over to R/O aorta dissection. By 8/8,had severe pain in right neck, half-way down chest each time breathed, and in area in crook of bones at shoulder and clavicle (R subclavian artery?), SOB. Voice hoarse. Each time touched vascular area=pain. back of head on pillow=pain. Abdom CT (no contrast) showed descending aorta to be ok, fuzzy ascending. Blood work ok/docs; No chg in carotid. Lungs ok. Doc heard some rubbing in lung area. Gave me Vioxx; decided on pleurisy.(Got impression he wasn't convinced of dx) Norm temp=95.7; hosp temp=98-99 but didn't count as high temp. When percep of low grade fever left, pain left. Still have trouble w/full breath. Gained 3 lbs abruptly and lost lbs abruptly. Area of chest bloated compared to normal pushing agains ribs until lost wt 8/18. Home bps abt 18 pts higher in rt than left (systolic) on 8/6; now abt 15 diff.

Cld this have been a subclavian dissection? Long term effects?
Cld it have still been aortic dissection? Diff betw symptoms for dissection and pleurisy?
Should I investigate further? Some info noticed at home after hosp. not known to doc. Important or is this a case closed?
Cardio was out of town. Shd I let him know of episode since dx=pleurisy?
EKG showed old anteroseptal infart? Is this a heart attack? (this was at time of undxd stroke, ekg results not reported to me) What are the consequences of an anteroseptal infarct?
Thnx

[CCF-M.D.-CRC]

Dear kd,

It dosen't sound like a dissection but the only way to be sure is with an angiogram.  If it were a dissection they can usually be watched but sometimes require stenting or surgery.  If you are still having symptoms I would recommend further evaluation.  It is probably not necessary to call your cardiologist for a nonrelated admission but it is always good to ask that copies of your records be sent to your various doctors. An anteroseptal infarct describes changes on the ECG that are consistent with an old heart attack.  Depending on the extent of damage to the heart consequences can range from minor to more serious and would include decreased heart function and rhythm problems.

[kd re: longstanding MR]

It would take me forever and a day to get as much info as you put in your paragraph.  Thank you.