Avtor/Urednik		Kržišnik-Zorman, Simona; Okrajšek, Renata
Naslov		Bolečina v prsnem košu pri pljučni emboliji
Prevedeni naslov		Chest pain in pulmonary embolism
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 41, št. Suppl 3
Leto izdaje		2002
Obseg		str. 57-60
Jezik		slo
Abstrakt		Chest pain as an initial presentation of pulmonary embolism occurs in about 70% of patients. In rare cases, pulmonary embolism may also mimic acute myocardial infarction, which was the case in our patient. This is a report about a patient included in a rehabilitation program after an ischemic cerebrovascular insult with right-sided hemiplegia and aphasia. He was admitted to our unit after syncope with documented hypotension and bradycardia. Upon admission, he had chest pain but was eupnoic and normotensive and his heart rate was 110/min. He had severe electrocardiographic changes suggesting extensive myocardial ischemia of the cardiac apex and lateral wall. Later, troponin T was slightly elevated (maximum 0.168 ng/1), but creatine kinase remained normal. An echocardiogram was immediately performed. While left ventricular function was normal without any wall motion abnormalities, the right ventricle was dilated with septal flattening. Doppler-derived pulmonary arterial systolic pressure was 87 mmHg. Pulmonary embolism was proven using a ventilation-perfusion scan and pulmonary angiography. We were partially successful in the fragmentation and aspiration of thrombi from both pulmonary arteries. The patient was treated with heparin and warfarin. The outcome was favorable. This case highlights the importance of early use of echocardiography in obtaining an accurate diagnosis, thus avoiding unnecessary and inappropriate treatment. The possible pathophysiology of chest pain in pulmonary embolism is discussed.
Izvleček		Bolečina v prsnem košu se po podatkih iz literature kot simptom pljučne embolije pojavlja pri približno 70 % bolnikov. V redkih primerih pljučna embolija lahko posnema akutni miokardni infarkt, kar opisujemo pri našem bolniku. Bolnik je bil v programu rehabilitacije po ishemičnem cerebrovaskularnem inzultu z desnostransko hemiplegijo in afazijo. K nam je bil sprejet po sinkopi z bradikardijo in hipotenzijo. Ob sprejemu ga je bolelo v prsih, bil je evpnoičen, normotenziven, tahikarden (110/minuto). Ugotovili smo hude elektrokardiografske spremembe, značilne za obsežno ishemijo apeksa in stranske stene levega prekata. Kasneje smo zasledili blag porast troponina T v serumu, medtem ko je kreatinkinaza ostala normalna. Takoj smo naredili ultrazvočno preiskavo srca. Funkcija levega prekata je bila normalna brez segmentnih motenj krčljivosti, desni prekat je bil povečan, medprekatni pretin pa sploščen. Doplersko izmerjen sistolni tlak v pljučni arteriji je znašal 87 mmHg. Pljučna embolija je bila dokazana z ventilacijsko-perfuzijskim scintigramom in pljučno angiografijo. Deloma uspešna je bila katetrska trombembolektomija iz obeh pljučnih arterij. Bolnik je kasneje prejemal heparin in kumarinski preparat. Nadalnji potek je bil brez zapletov. Primer opozarja na pomen ultrazvočne preiskave srca pri diagnostiki bolnikov z bolečino v prsnem košu. V članku so opisani možni patofiziološki mehanizmi bolečine v prsnem košu pri pljučni emboliji.
Deskriptorji		CHEST PAIN PULMONARY EMBOLISM AGED ELECTROCARDIOGRAPHY EXERCISE TEST