CHEST Guidelines-A-54-Year-Old-Woman-With-Chest-Pain-and-Shortness-

A-54-Year-Old-Woman-With-Chest-Pain-and-Shortness-

Pdf Summary

A 54-year-old woman with a history of endometrial cancer presented to the emergency department with chest pain and shortness of breath, alongside symptoms like nausea and decreased appetite. She was afebrile, had rapid breathing with a decreased oxygen saturation of 90%, and exhibited difficulty speaking full sentences. Physical examination revealed swelling and warmth in the left lower extremity, suggestive of deep vein thrombosis (DVT). Lab results showed elevated creatinine and brain natriuretic peptide (BNP) levels, but a normal troponin level and ECG. A CT angiogram indicated an extensive pulmonary embolism (PE) with clots in the right main pulmonary artery and left lower lobar artery, along with right ventricular (RV) strain. <br /><br />Upon admission, she was treated with heparin, but her condition worsened, requiring transfer to the medical ICU, where a bedside echocardiogram was conducted. Measurements indicated significant RV dilation and elevated RV systolic pressure, consistent with pulmonary hypertension. Deciding to administer thrombolytic therapy, post-treatment imaging showed notable improvement in RV strain and pressure parameters.<br /><br />The discussion emphasized the importance of prompt echocardiographic evaluation, advocating for thrombolytic therapy in high-risk submassive PE cases. Echocardiography not only aids in diagnosis but allows real-time decision-making without delays typically associated with formal echocardiograms. These swift actions by the ICU team facilitated rapid management, mitigating the risk of hemodynamic deterioration.<br /><br />This case underscores bedside echocardiography’s integral role in evaluating RV function and guiding treatment for conditions such as PE. The MICU team's ability to assess, interpret, and act on ultrasound findings in real time exemplifies effective emergency medical response and management.

Keywords

endometrial cancer

chest pain

shortness of breath

pulmonary embolism

deep vein thrombosis

echocardiography

thrombolytic therapy

ICU

RV strain

emergency response