Dyspnea in the emergency department at night

Dispnea in Pronto Soccorso di notte

Abstract

Acute pulmonary embolism (PE) interferes with both blood circulation and gas exchange. Right ventricular failure due to pressure overload is considered the leading cause of death by PE. The diagnosis of PE can be difficult, as the symptoms are often non-specific (dyspnea, chest pain, pre-syncope or syncope, hemoptysis). In particular, chest pain may be typical and derive from ischemia of the right ventricle: in these cases a differential diagnosis with acute coronary syndrome or with aortic dissection is necessary. If EP is suspected, it is therefore necessary to proceed promptly to the recommended diagnostic investigations. The case of a 62-year-old smoker suffering from arterial hypertension, dyslipidemia, non-insulin-dependent diabetes and chronic ischemic heart disease is reported here, admitted to emergency room for increasing dyspnea from mild stress in the absence of trauma, prolonged bed rest or fever. In suspicion of PE, CT angiography with contrast agent was performed for the study of the arterial tree, which confirmed the diagnosis of venous thromboembolism. The patient is treated with supporting tights, unfractionated heparin, and dabigatran is subsequently started (Cardiology).