CHEST Guidelines-A-48-Year-Old-Woman-Presenting-With-Syncope-and-Sh

A-48-Year-Old-Woman-Presenting-With-Syncope-and-Sh

Pdf Summary

A 48-year-old woman with no previous medical history or recent travel presented to the emergency department (ED) following a syncope at home, accompanied by shortness of breath on exertion over three days. She had low oxygen saturation (89-90%), tachycardia, and no chest pain or extremity swelling. Upon examination in the ED, she showed signs of hypoxemia, respiratory alkalosis, and sinus tachycardia with an irregular ECG indicating right ventricular strain. A multiorgan ultrasound revealed significant right heart strain and a deep vein thrombosis (DVT) in the right leg. A CT pulmonary angiogram confirmed the presence of a bilateral pulmonary embolism with right ventricular strain, diagnosing it as a submassive pulmonary embolism (PE).<br /><br />Submassive PE is characterized by right ventricular dysfunction without hypotension, affecting 20% of PE cases with an in-hospital mortality rate of about 5%. Accurate diagnosis was supported by the use of multiorgan point-of-care ultrasound (POCUS), which has shown predictive value for PE diagnoses. Treatment controversy exists; while thrombolysis is beneficial for massive PE, its use in submassive cases is debated due to potential bleeding risks, as highlighted by the PEITHO trial findings. In this case, the patient was managed with anticoagulation therapy and monitored due to her stable condition.<br /><br />The case underscores the utility of integrating cardiac, pulmonary, and deep vein ultrasound evaluations in diagnosing PE in the ED. Effective diagnosis and management of submassive PE require balancing the risks and benefits of treatment options, emphasizing the need for further studies on POCUS efficacy in such scenarios. The patient was discharged after seven days on anticoagulation therapy and showed complete recovery on follow-up.

Keywords

submassive pulmonary embolism

right ventricular strain

deep vein thrombosis

multiorgan ultrasound

point-of-care ultrasound

anticoagulation therapy

PEITHO trial

syncope

hypoxemia

tachycardia