Fool Me Once: An Uncommon Presentation of PE

​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; &AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and it showed significant elevation at 4,360. PA and lateral chest x-rays were notable for mild cardiomegaly without any focal consolidation or pulmonary edema. A 12-lead ECG showed a left axis deviation, incomplete right bundle branch block, prolonged QT interval, and poor R wave progression with T wave inversions in inferolateral leads (aVF, V2-V5).She was admitted for an acute inferolateral NSTEMI, and empirically managed with aspirin 81 mg daily, metoprolol 12.5 mg twice daily, and atorvastatin 40 mg daily. Her troponin I showed a downward trend, and cardiology performed a coronary angiogram, which was unremarkable for clinically emergent coronary artery pathologies. The patient also had a bilateral lower extremity venous Doppler study evident for left lower extremity chronic DVT and right lower extremity subacute DVT.Further study was recommended to rule out ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Occupational therapy Professional topics Resilience Science in practice Source Type: blogs
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Source: Trends in Molecular Medicine - Category: Molecular Biology Authors: Tags: Trends Mol Med Source Type: research
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Source: Zoological Science - Category: Zoology Authors: Tags: Zoolog Sci Source Type: research
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Source: Mol Biol Cell - Category: Molecular Biology Authors: Tags: Methods Mol Biol Source Type: research
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Source: Mol Biol Cell - Category: Molecular Biology Authors: Tags: Methods Mol Biol Source Type: research
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Source: Mol Biol Cell - Category: Molecular Biology Authors: Tags: Methods Mol Biol Source Type: research
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Source: Drug Development and Industrial Pharmacy - Category: Drugs & Pharmacology Tags: Drug Dev Ind Pharm Source Type: research
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Source: Expert Review of Clinical Immunology - Category: Allergy & Immunology Tags: Expert Rev Clin Immunol Source Type: research
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