39

39 CASE 39


A 66-year-old woman is brought into the clinic by her husband after she began to complain of severe chest pain exacerbated with inspiration.


The patient states that she began feeling pain in her chest and thought she was having a heart attack. She states that the pain was increased when she inhaled. She feels like she can’t breathe and complains that her heart won’t stop racing. Prior medical history reveals that she had been treated for clots in her legs 6 months ago. She states that she got better and stopped taking the warfarin she was prescribed because she didn’t like the way it made her feel. She admits to having bouts of calf pain over the past few weeks but thought it was a result of her recent attempts to improve her health by taking evening walks.



PHYSICAL EXAMINATION



VS: T 37.2°C, P 95/min, R 26/min, BP 128/92 mm Hg, BMI 33

PE: Patient shows dyspnea with intermittent bouts of coughing. Grimacing is evident on inspiration with guarding action of holding chest. Auscultation of the lungs reveals significant rales. There is localized wheezing and a pleural friction rub.


LABORATORY STUDIES



Pulse oximetry: 85% oxygen saturation

ECG: Sinus tachycardia rhythm, S1Q3T3 (cor pulmonale) T-wave inversion in V1 to V4, and right ventricular strain

Chest radiograph: Elevated diaphragm, pleural effusion, atelectasis, and dilation of the pulmonary artery

Arterial blood gases: PO2 95 mm Hg, PCO2 40 mm Hg, pH 7.48

Expiratory end-tidal respiratory gases: PO2 105 mm Hg and PCO2 38 mm Hg

Ventilation/perfusion lung scan: Positive if more than two segmental perfusion defects in the presence of normal ventilation

Spiral CT: Positive for medium-sized pulmonary embolism
< div class='tao-gold-member'>

Related posts:

  1. 21
  2. 23
  3. 58
  4. 71

Stay updated, free articles. Join our Telegram channel
Tags:
Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 39

Full access? Get Clinical Tree
Get Clinical Tree app for offline access