Necip ERMİS, Cem DOGAN, Suzan Hatipoglu AKPİNAR

Semptomatik koroner arter hastalığı olan bir hastada akut pulmoner embolizm

Pulmoner embolizm spesifik olmayan semptomatoloji ve laboratuvar bulguları nedeniyle bazen tanı konulması zor olan, yaşamı tehdit eden acil bir durumdur. Stabil angina pektoris öyküsü olan 65 yaşındaki bir kadın, acil servisimize ciddi akut nefes darlığı ve göğüs ağrısı nedeniyle başvurdu. EKG'de V1'den V6'ya kadar T negatifliği saptandı ve ilk troponin değeri 16.8 ng/ml, D-dimer 897?g/L idi. Laboratuvar ve ekokardiyografik bulgular, klinik tablo kesin tanıyı koymada yetersiz kaldığı için hastayı koroner ve pulmoner anjiyografi yapmak maksatlı kateter laboratuvarına gönderdik. Kateter laboratuvarında sol ön inen koroner arter proksimal-orta kısmında ciddi daralma ve sol ana pulmoner arterde geniş bir trombo-emboli nedeniyle kısmi tıkanıklık saptadık ve başarılı bir şekilde tedavi ettik.

Acute pulmonary embolism in a patient with symptomatic coronary artery disease

Pulmonary embolism (PE) is a life-threatening emergency that is sometimes difficult to diagnose due to nonspecific symptomatology and laboratory findings. A 65 years old women who has past stable angina pectoris history was admitted to the our emergency department with severe acute dyspnea and chest pain. The ECG revealed negative T waves in leads V1 through V6 and initial troponin was 16.8 ng/ml and Ddimer 897?g/L. Since these both laboratory and echocardiographic findings and clinical presentation did not let us establish a definite diagnosis, we sent the patient to the catheterization laboratory in order to perform both coronary and pulmonary angiography. We detected severe stenosis of proximal-mid left anterior descending artery and partially occluded left main pulmonary artery by large thrombo-emboli at the catheterization laboratory and treated successfully.

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