Elevated brain natriuretic peptide and troponin I in a woman with generalized weakness and chest pain.
We report the case of a female patient emergently transferred to our institution with the presumptive diagnosis of myocardial infarction in heart failure given the constellation of symptoms and abnormal laboratory cardiac markers on presentation. However, on closer examination, prior to instituting an invasive cardiac work-up, pulmonary embolism was instead strongly considered to explain a common etiology. Therefore, an echocardiogram was promptly obtained, which revealed the presence of McConnell's sign. This noninvasive imaging modality proved to be critical in the prompt recognition and management of this patient. We reviewed the literature regarding the use of echocardiography and the clinical significance of abnormal cardiac markers in patients presenting pulmonary embolism.
Simpson
Joanne
J
Department of Medicine, University of Pittsburgh Medical Center, Presbyterian hospital, Pittsburgh, Pennsylvania, USA.
López-Candales
Angel
A
D000368:Aged; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D045283:Natriuretic Agents / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis*; D013977:Tibia / Q000098:blood supply; D019210:Troponin I / Q000097:blood*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging
D045283:Natriuretic Agents; D019210:Troponin I; D020097:Natriuretic Peptide, Brain