A 51-Year-Old Woman With Sudden Onset of Dyspnea and Tachycardia

Disclosures

December 03, 2001

Case Presentation

A 51-year-old female was hospitalized after suffering sudden right calf pain, with no associated inflammation, followed by recurrent episodes of severe dyspnea, chest tightness, sweating, and hypotension. Her past medical history is significant for bronchial asthma for which she has been prescribed inhaled steroids and beta-2 agonists for 12 years. She was placed on estrogen therapy two years prior to admission for alleviation of climacteric symptoms. Previously done chest radiograph, resting lung function, arterial blood gases, and electrocardiogram were reported as normal. There is a family history of ischemic heart disease.

Physical Examination

On physical examination, patient was diaphoretic. Measurement of vital signs revealed hypotension (SBP: 80mmHG), tachypnea (respirations > 25 breaths/min), and tachycardia (HR=102 beats/min). There were no physical findings suggesting deep vein thrombosis (DVT). No cough or hemoptysis were noted.

Laboratory Findings and Radiography

Laboratory studies revealed: PaO2=61mmHg (hypoxemia defined as severe when arterial oxygen pressure (PaO2) is normalized for PaCO2); PaCO2=31mmHg; pH=7.47; SaO2=91% on air. Arterial oxygen percent saturation did not increase with oxygen administration.

Electrocardiogram showed sinus tachycardia with negative T waves in leads V1 through V3 (Fig. 1). Chest radiograph was normal.

Standard 12-lead ECG at admission showing sinus tachycardia and negative T wave in leads V1 through V3. Previous electrocardiographic tracings were normal.

On the basis of history, physical exam, laboratory and radiographic findings, the diagnosis of acute pulmonary embolism (PE) was made.

In order to confirm the diagnosis and choose the appropriate therapy, what study would you perform?

  1. Perfusion lung scan

  2. Ventilation/perfusion lung scan

  3. Echocardiography

  4. Pulmonary angiography

  5. Spiral computed tomography (CT)

View the correct answer.

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