Acute Pulmonary Embolism Mimics Acute Coronary Syndrome in Older Patient

Accepted 10 March 2009.

Summary

Acute pulmonary embolism is a fatal disease and an often missed diagnosis. There are no specific symptoms or signs. Accurate diagnosis followed by effective therapy can reduce mortality. We report on a 67-year-old man who underwent lumbar laminectomy and developed an acute anterior compressive-like chest pain and jaw numbness rather than dyspnea on the fifth postoperative day. Owing to refractory chest pain with suspicious posterior myocardial infarction or unstable angina on surface electrocardiogram, the patient received emergency coronary catheterization, which demonstrated normal coronary arteries. Further investigation provided a final diagnosis of acute pulmonary embolism. Acute pulmonary embolism with simultaneous recent neuro-surgery was a therapeutic dilemma because of the risk of postoperative hemorrhage threatening neurologic function. After treatment with enoxaparin and close monitoring of his neurologic condition, his symptoms were eliminated. Clinicians must keep in mind a differential diagnosis of pulmonary embolism in a postoperative high-risk patient.

Key Words: acute coronary syndrome , laminectomy , pulmonary embolism

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Article Outline

• Summary

• References

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References

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a Cardiovascular Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

b Mackay Medicine, Nursing and Management College, Taipei, Taiwan

c School of Medicine, Taipei Medical University, Taipei, Taiwan

Correspondence to: Dr Chun-Chieh Liu, Cardiovascular Medicine, Department of Internal Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 10449, Taiwan

PII: S1873-9598(10)70010-7

doi:10.1016/S1873-9598(10)70010-7

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