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“Lost consciousness on the job…” Case Conclusion December 6, 2012

Posted by Andy Jagoda, MD in : Cardiovascular , trackback

The 49-year-old construction worker, acute coronary syndromes was your primary concern; however, given the patient’s recent history of deep vein thrombosis, a CTPA was ordered to assess for PE. This showed multiple central pulmonary emboli, including a saddle embolism. The exact wording at the end of this preliminary reading was, “clinically correlate if patient still alive.” You performed bedside cardiac ultrasound and saw a dilated right ventricle. Based on these findings, the patient was admitted to the ICU. Approximately 6 hours later, the patient became increasingly dyspneic and tachycardic. A repeat bedside ultrasound showed increased dilatation of the right ventricle. The patient was taken emergently to angiography, where rt-PA was administered into the central pulmonary vasculature. The patient’s hemodynamics improved, as did his symptoms. He was eventually discharged from the hospital on warfarin therapy.

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