A deadly tear to fear: An interesting case presentation

Objectives@#1) To present a case of a patient with aortic dissection. 2) To show how the case arrived to its plausible diagnosis. 3) To discuss other illnesses discovered in the case.@*Case Summary@#This is a case of a 54-year old, female, Filipino, Catholic, who presented with severe chest pain, substernal in location, with pain intensity of 8/10 associated with diaphoresis and dyspnea leading to fainting spells. Initial impression was cardiogenic shock secondary to Non-ST elevated myocardial infarction. On physical examination, the patient was drowsy and in cardio-respiratory distress. She had symmetrical chest expansion and no retractions were noted. Clear breath sounds were noted in all lung fields. She had an adynamic precordium with normal rate and regular rhythm, however with distant heart sounds. There was no murmur, heave or thrill appreciated. Vital signs at the emergency room showed a blood pressure of 110/80 which eventually became 80/50 mmH, respiratory rate of 22 cycles per minute, heart rate of 80-100 beats per minute and was febrile. Patient was scheduled for a stat coronary angiography, however on further reassessment, repeat ECG showed resolution of the inferolateral wall ischemia but this could not explain her fluctuating blood pressure. When the patient underwent the scheduled bedside 2D echo, a moderate cardiac tamponade was discovered with a 4.5 cm aortic dissection. With these findings, patient underwent aortic repair, graft insertion with evacuation of hematoma. She was discharged stable and with no recurrence of chest pain.

Intensifying health promotion efficiency through relevant flipchart use: A primary health care learning empowerment for community health workers of the Municipality of Sto. Tomas, Batangas, Philippines

@#Primary Health Care is the essential care based on practical, scientifically sound and socially acceptable method and technology made universally accessible to individuals and families in the community through their full participation and at a cost they and the community can afford to maintain in the spirit of self-reliance and self-determination. Last September, 1978 at Alma Ata, an international conference on primaiy health care was done and they declared that Health is a fundamental human right and that the attainment of the highest possible level of health is a most important world wide social goal and that the people have the right and duty to participate individually and collectively in the planning and implementation of their health care.