challenging case: an obese 60yo patient never seen by a doctor as an adult presents marked peripheral edema, hypertension, and 2 months of worsening DOE, PND, orthopnea. BNP 400, EKG Unremarkable, trop 0.1, stating well. It feels like CHF. But the cardiologist wants a CTPE. We oblige – big saddle embolus with RV strain. This is apparently very common. Read more, follow the link http://circ.ahajournals.org/content/118/15/1598.full
Jun 07
CHF or PE? PE is a known and common complication of CHF
2 comments
For CDU providers, this is good information to keep in mind for any patient with dyspnea, particularly when patients do not respond as expected to protocols for CHF, as well as COPD/asthma. For example, there was a patient admitted to the CDU for asthma a while back, and she was not responding to the standard treatment. We ran a CTPE, and it was positive. Regarding CHF, it’s useful to know these patients are at higher risk for PE.
A great reminder…when something doesn’t fit about a patient’s presentation, look for an alternative answer.