[Pulmonary embolism: a difficult diagnostic problem].
BACKGROUND
The mortality of untreated pulmonary embolism (PE) is estimated at approximately 30% of patients, whereas treatment decreases it to 2-8%. A specific combination of symptoms present in PE may suggest other cardiac or lung disorder.


OBJECTIVE
To evaluate frequencies of clinical symptoms and changes in diagnostic investigations misleading to the recognition of acute coronary syndrome (ACS) or lung diseases (Ld) in PE patients.


METHODS
Retrospective analysis of 154 records of individuals with recognized PE allowed to divide patients into groups suggestive of ACS (min. 2 of: chest pain, ischemic changes on electrocardiogram (ECG) and elevated cardiac troponin T level [cTnT >0.01 ng/ml]) or suggestive of the Ld (min. 2 of: dyspnea, cough, fever, lung consolidations on chest radiograph).


RESULTS
Fifty-five (36%) patients were classified to the ACS group and 54 (35%) to Ld group, while 69 (45%) patients were not included to either group. Twenty-four (16%) patients fulfilled criteria of both groups. There were no significant differences in the frequency of coronary heart disease, heart failure, atrial fibrillation and chronic obstructive pulmonary disease between groups. Elevated troponin level was observed in 68% of patients with chest pain and changes on ECG, and in 26% of patients without coexistence of these symptoms (p < 0.05).


CONCLUSIONS
In most patients with final diagnosis of PE, symptoms and initial investigation results can mislead to the diagnosis of ACS or lung disease. The chest pain and ischemic changes on ECG are frequently associated with the myocardial injury resulting in increased troponin levels in PE patients.
Łabyk
Andrzej
A
Katedra i Klinika Chorób Wewnetrznych, Nadciśnienia Tetniczego i Angiologii, Akademia Medyczna, Warszawa.
Kalbarczyk
Anna
A
Piaszczyk
Agata
A
Kostrubiec
Maciej
M
Kaczyńska
Anna
A
Bochowicz
Anna
A
Pruszczyk
Piotr
P
D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis*; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology; D006329:Heart Conduction System; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D020107:Troponin T / Q000097:blood
D020107:Troponin T