Acute Cor Pulmonale from Massive Bilateral Pulmonary Emboli

摘要

In the United States, pulmonary embolism (PE) is a common cause of morbidity and mortality. Several authors have described the EKG changes associated with PE, the presence of a S1 Q3 T3 is suggestive of right heart strain and cor pulmonale. We present a case of 62 y/o male on day number 20 s/p radical cysto-prostatectomy and neobladder for Urothelial Cell Carcinoma, who after a long automobile trip developed acute cor pulmonale from a lethal pulmonary embolism. Case Presentation This is the case of a 62 y/o male on day number 20 s/p radical cysto-prostatectomy and neobladder for Urothelial Cell Carcinoma. Days prior to the Emergency Department visit he was hospitalized at another institution for a partial small bowel obstruction that resolved. Patient was sent to our hospital for a urological evaluation, to get to our institution patient drove approximately four hours, upon arrival to our city patient became acutely short of breath, tachycardic with chest discomfort and light-headedness Emergency Medical Services transporting the patient to our Emergency Department were initial vital signs were significant for a heart rate of 130's Blood Pressure of 80/50s and a respiratory rate of 35-40. The patient developed Acute Cor Pulmonale as witnessed by and EKG demonstrating an S1Q3T3 and new right bundle branch block (figure-2) with a comparison EKG from three weeks earlier (figure-1) demonstrating a normal sinus rhythm, this phenomenon resulted from massive bilateral pulmonary emboli (PE) as seen in figure-3.