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Transverse arch of aorta

Neck pain radiating to the shoulders

Sudden, sharp tearing

Descending aorta

Back and shoulder pain radiating to the chest

Sharp, tearing

hemoptysis, dyspnea, or stridor, which may be caused by a descending thoracic aortic aneurysm that compresses the tracheobronchial tree. Ask if the patient has had difficulties swallowing, hoarseness, dyspnea, or dry cough, all of which may be caused by a transverse arch thoracic aortic aneurysm.

PHYSICAL EXAMINATION. The physical examination of a patient with a thoracic aortic aneurysm does not reveal the presence of the aneurysm itself. Certain physical findings, however, should raise your level of suspicion. Complete a neurological examination to determine the adequacy of tissue perfusion. Take the patient's blood pressure in both arms because an ascending thoracic aortic aneurysm may cause a contralateral (opposite side) difference. Take both the patient's right carotid and left radial pulses and note any differences. Auscultate for pericardial friction rub and aortic valve insufficiency murmur, indicating the extension of an ascending aortic aneurysm proximally into the aortic valve. Note any signs of bradycardia.

PSYCHOSOCIAL. Assess the patient's and significant others' understanding of the implications of the condition. Assess the ability of the patient and significant others to cope with a sudden life-threatening illness, a prolonged hospitalization, and the role changes that a sudden illness requires. Assess the patient's level of anxiety about the illness, potential surgery, and complications.

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