0
ONLINE EXCLUSIVES
Ultrasound Corner |

An 82-Year-Old Woman With Ongoing Dyspnea

Guido Tavazzi, MD; Gabriele Via, MD; Antonio Braschi, MD; Susanna Price, MD, PhD
Author and Funding Information

aDepartment of Anesthesia, Intensive Care and Pain Therapy, University of Pavia, Pavia, Italy

bDepartment of Anesthesia and Intensive Care and Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

cDepartment of Adult Intensive Care, Royal Brompton Hospital NHS Foundation Trust, London, England

CORRESPONDENCE TO: Guido Tavazzi, MD, Fondazione IRCCS Policlinico San Matteo, Department of Anesthesia, Intensive Care and Emergency Medicine, Viale Camillo Golgi 19, 27100, Pavia (PV), Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):e9-e11. doi:10.1016/j.chest.2016.02.687
Text Size: A A A
Published online

Extract

An 82-year-old woman presented to the ED with severe dyspnea and hypertension (200/133/100 mm Hg). Her medical history included chronic obstructive pulmonary disease and a recent admission for heart failure that was treated with furosemide and a calcium channel blocker. Her ECG was known to show left bundle branch block. Chest auscultation revealed bilateral bibasal crackles. Her oxygen saturation was 92% using helmet CPAP (Fio2, 60%; positive end-expiratory pressure, 10 cm of water). Arterial blood gas analysis revealed a pH of 7.30, Pao2 of 66 mm Hg, Paco2 of 54 mm Hg, a hemoglobin value of 15.9 g/dL, and a lactate level of 1.8 mg/dL. The brain natriuretic peptide level was 350 ng/dL and both 3-h and 6-h troponin I (TnI) assays were negative (0.04 ng/mL). The creatinine level was 1.72 mg/dL and the BUN level was 75 mg/dL. The ECG showed sinus rhythm (85 beats/min), complete left bundle branch block, QS in V1-V2 with no new changes on the ECG suggestive of cardiac ischemia. Lung ultrasonography (LUS) revealed bilateral pleural effusions and features consistent with pulmonary interstitial syndrome. Focused cardiac ultrasonography (FoCUS) demonstrated mild left ventricular (LV) dilatation with moderate to severe LV systolic dysfunction (ejection fraction [EF], 35%) with no other abnormalities. Chest radiography confirmed the LUS findings (Video 1). Acute coronary syndrome was ruled out, and the diagnosis of acute decompensation of chronic hypertensive heart disease was made. She was treated with intravenous urapidil and furosemide, with substantial improvement allowing transfer to the general medical ward.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543