Early echocardiography approach is fundamental in leading diag-nosis and treatment of acute dyspnea. A 92 years hold woman suf-fering from Alzheimer’s disease was admitted to the Emergency Room for acute breathlessness occurred during the meal. She wasfind to be normotensive, with a new atrial fibrillation on ECG, amildly elevated troponin (1,03 ng/ml) and low saturation levels.Haemogasanalysis showed mild hypossiemia and normocapnia.Laboratory tests evidenced neutrophilic leukocytosis and chest raysevidenced a shaded lung opacity suspected for ab-ingestis pneu-monia. The picture revealed its underlying complexity when echocar-diographic study evidenced an associated pulmonary embolismcharacterized by intra-atrial thrombosis, right sections enlargementwith regional wall motion abnormalities sparing the right ventricularapex (Mc Connel’s sign), mild tricuspid regurgitation and systolicpulmonary artery pressure of 50 mmHg. Continuous intravenousheparin was suddenly started while performing lower limb ultra-sonography which confirmed the diagnosis of pulmonary embolismbecause of the presence of both common and superficial femoralthrombosis. Despite early diagnosis and treatment, unfortunatelythe patient died during another flare of dyspnea due to post-mealvomit thus confirming the precedent suspicion of a double genesysdispnea and the importance of a comprehensive evaluation of crit-ical patients.
The role of echocardiography in first line assessmentof dyspnea
L. FalsettiWriting – Original Draft Preparation
;
2013
Abstract
Early echocardiography approach is fundamental in leading diag-nosis and treatment of acute dyspnea. A 92 years hold woman suf-fering from Alzheimer’s disease was admitted to the Emergency Room for acute breathlessness occurred during the meal. She wasfind to be normotensive, with a new atrial fibrillation on ECG, amildly elevated troponin (1,03 ng/ml) and low saturation levels.Haemogasanalysis showed mild hypossiemia and normocapnia.Laboratory tests evidenced neutrophilic leukocytosis and chest raysevidenced a shaded lung opacity suspected for ab-ingestis pneu-monia. The picture revealed its underlying complexity when echocar-diographic study evidenced an associated pulmonary embolismcharacterized by intra-atrial thrombosis, right sections enlargementwith regional wall motion abnormalities sparing the right ventricularapex (Mc Connel’s sign), mild tricuspid regurgitation and systolicpulmonary artery pressure of 50 mmHg. Continuous intravenousheparin was suddenly started while performing lower limb ultra-sonography which confirmed the diagnosis of pulmonary embolismbecause of the presence of both common and superficial femoralthrombosis. Despite early diagnosis and treatment, unfortunatelythe patient died during another flare of dyspnea due to post-mealvomit thus confirming the precedent suspicion of a double genesysdispnea and the importance of a comprehensive evaluation of crit-ical patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
