Open AccessPicture Quiz: Abdominal Pain in a patient receiving low molecular weight heparin
Author(s) -
U Nandy,
GI Varughese,
Nayyar Iqbal,
Constable Tj
Publication year - 2005
Publication title -
acute medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.14
H-Index - 12
eISSN - 1747-4892
pISSN - 1747-4884
DOI - 10.52964/amja.0104
Subject(s) - medicine , blood pressure , abdominal pain , iliac fossa , tenderness , chest pain , surgery , anesthesia , low molecular weight heparin , abdomen , physical examination , ischaemic heart disease , heparin , cardiology
A 63 year old lady with known ischaemic heart disease was admitted to hospital with cardiac sounding chest pain. Blood pressure was 161/80 on admission, and full examination was unremarkable. ECG showed ischaemic changes in the inferior leads, and a diagnosis of unstable angina was made. Troponin I was undetectable. She was treated with subcutaneous Enoxaparin 1.5mg/kg and an intravenous nitrate infusion. Her pain settled the following day, allowing the nitrate infusion to be weaned off, although the Enoxaparin treatment was continued, pending a cardiology opinion. On the third day after admission she collapsed on the ward with a blood pressure of 95/59mmHg; examination revealed lower abdominal tenderness with a mass in the right iliac fossa. Blood tests showed that her haemoglobin had dropped by 5 grams/decilitre, she underwent urgent abdominal ultrasound followed by CT (see below).