Management of a patient with pulmonary embolism and symptoms of acute coronary syndrome — a case study

Abstract

Background: Pulmonary embolism (PE) is a life-threatening condition. It is the third leading cause of cardiovascular-related deaths after myocardial infarction and cerebral stroke. The diversity and intensity of PE symptoms often suggest another cause of gravity of patient’s condition; this can create problems and delays in correctly diagnosing and starting suitable treatment of PE. Differential diagnosis of pulmonary embolism requires taking into consideration acute coronary syndrome, pneumonia, exacerbation of chronic obturatory pulmonary disease, bronchial asthma, pneumothorax, cardiac tamponade and aortic dissection.
Case description: A 67 year-old man was air-lifted from a regional hospital to the emergency room at the Clinic of Cardiology, Medical University of Silesia in Katowice. He had been diagnosed with acute coronary syndrome without ST segment elevation. The patient’s condition at admission was very serious; he presented with general weakness, difficulties in verbal communication, upper chest pain, and considerable dyspnea. Total clinical picture and additional tests performed at the emergency room indicated pulmonary embolism. The PE diagnosis was confirmed based on characteristic changes visualized by echocardiographic and CT scans; appropriate treatment was then initiated. Currently, the patient is under cardiological ambulatory care.
Conclusions: The described case of pulmonary embolism presents an example of actual difficulties experienced when diagnosing this disease unit since its clinical picture can imitate various other conditions. The successful treatment of a pulmonary embolism patient at the Center of Cardiology underscores the paramount role of the time factor and diagnostic/treatment capabilities in such an outcome. It demonstrates the relevance of prompt transfer of such patients to facilities offering specialized treatment.

Polish Surgery 2010, 12, 2, 103–111