[Massive pulmonary embolism mimicking ST-elevation acute coronary syndrome successfully treated with hybrid therapy in a trauma patient receiving nadroparin: diagnostic and therapeutic dilemmas].
A case of a 48-year-old woman with a comminuted fracture of the left tibia and receiving prophylactic doses of nadroparin, with massive pulmonary embolism mimicking ST-elevation acute coronary syndrome and complicated by cardiogenic shock and cardiac arrest, is presented. Pulmonary angiography showed total right pulmonary artery occlusion. Intraarterial thrombolysis with reduced dose of alteplase (50 mg), platelet GP IIb/IIIa blockade with eptifibatide, endovascular embolus fragmentation with a pigtail rotation catheter, and rescue pulmonary balloon angioplasty were performed, after which complete recovery was achieved. On day 4 of hospitalisation the patient was transferred to the orthopaedic ward where she underwent uneventful tibial surgery.
Latacz
Paweł
P
Klinika Choroby Wieńcowej, Instytut Kardiologii Collegium Medicum UJ, ul. Pradnicka 80, 31-202 Kraków. platacz@poczta.onet.pl
Rostoff
Paweł
P
Wyderka
Rafał
R
Rudnik
Andrzej
A
Kondys
Marek
M
Marut
Agata
A
Buszman
Paweł
P
Piwowarska
Wiesława
W
D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000790:Angiocardiography; D000800:Angioplasty, Balloon; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D000077542:Eptifibatide; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D017762:Nadroparin / Q000627:therapeutic use; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D013978:Tibial Fractures / Q000150:complications / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D017762:Nadroparin; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator; D000077542:Eptifibatide