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      Une embolie pulmonaire simulant un syndrome coronarien aigu Translated title: Pulmonary embolism mimicking acute coronary syndrome

      case-report

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          Abstract

          L'embolie pulmonaire est affection médicale aiguë et grave. Sa présentation clinique n'est pas pathognomonique et peut simuler d'autres urgences médico-chirurgicales. Nous rapportons le cas d'un patient admis dans un tableau de syndrome coronarien aigu avec modification électrique et ascension des enzymes cardiaques sans substrat significatif à la coronarographie, faisant diagnostiquer une embolie pulmonaire.

          Translated abstract

          Pulmonary embolism is an acute and severe medical condition. Its clinical characteristics are not pathognomonic and can mimick other medico-surgical emergencies. We report the case of a patient admitted with a clinical manifestation of acute coronary syndrome with electrical changes and elevation in cardiac enzymes without abnormal substrate on the coronarography, enabling diagnosis of pulmonary embolism.

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          Most cited references19

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          2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.

          Stavros V Konstantinides, Adam Torbicki, Giancarlo Agnelli … (2014)
          Article 0 comments Cited 694 times – based on 0 reviews     Review now
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            Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer.

            P. S. Wells, D Anderson, M. Rodger … (2000)
            We have previously demonstrated that a clinical model can be safely used in a management strategy in patients with suspected pulmonary embolism (PE). We sought to simplify the clinical model and determine a scoring system, that when combined with D-dimer results, would safely exclude PE without the need for other tests, in a large proportion of patients. We used a randomly selected sample of 80% of the patients that participated in a prospective cohort study of patients with suspected PE to perform a logistic regression analysis on 40 clinical variables to create a simple clinical prediction rule. Cut points on the new rule were determined to create two scoring systems. In the first scoring system patients were classified as having low, moderate and high probability of PE with the proportions being similar to those determined in our original study. The second system was designed to create two categories, PE likely and unlikely. The goal in the latter was that PE unlikely patients with a negative D-dimer result would have PE in less than 2% of cases. The proportion of patients with PE in each category was determined overall and according to a positive or negative SimpliRED D-dimer result. After these determinations we applied the models to the remaining 20% of patients as a validation of the results. The following seven variables and assigned scores (in brackets) were included in the clinical prediction rule: Clinical symptoms of DVT (3.0), no alternative diagnosis (3.0), heart rate >100 (1.5), immobilization or surgery in the previous four weeks (1.5), previous DVT/PE (1.5), hemoptysis (1.0) and malignancy (1.0). Patients were considered low probability if the score was 4.0. 7.8% of patients with scores of less than or equal to 4 had PE but if the D-dimer was negative in these patients the rate of PE was only 2.2% (95% CI = 1.0% to 4.0%) in the derivation set and 1.7% in the validation set. Importantly this combination occurred in 46% of our study patients. A score of <2.0 and a negative D-dimer results in a PE rate of 1.5% (95% CI = 0.4% to 3.7%) in the derivation set and 2.7% (95% CI = 0.3% to 9.0%) in the validation set and only occurred in 29% of patients. The combination of a score < or =4.0 by our simple clinical prediction rule and a negative SimpliRED D-Dimer result may safely exclude PE in a large proportion of patients with suspected PE.
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              Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial.

              Marc Righini, Grégoire Le Gal, Drahomir Aujesky … (2008)
              Multislice CT (MSCT) combined with D-dimer measurement can safely exclude pulmonary embolism in patients with a low or intermediate clinical probability of this disease. We compared this combination with a strategy in which both a negative venous ultrasonography of the leg and MSCT were needed to exclude pulmonary embolism. We included 1819 consecutive outpatients with clinically suspected pulmonary embolism in a multicentre non-inferiority randomised controlled trial comparing two strategies: clinical probability assessment and either D-dimer measurement and MSCT (DD-CT strategy [n=903]) or D-dimer measurement, venous compression ultrasonography of the leg, and MSCT (DD-US-CT strategy [n=916]). Randomisation was by computer-generated blocks with stratification according to centre. Patients with a high clinical probability according to the revised Geneva score and a negative work-up for pulmonary embolism were further investigated in both groups. The primary outcome was the 3-month thromboembolic risk in patients who were left untreated on the basis of the exclusion of pulmonary embolism by diagnostic strategy. Clinicians assessing outcome were blinded to group assignment. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00117169. The prevalence of pulmonary embolism was 20.6% in both groups (189 cases in DD-US-CT group and 186 in DD-CT group). We analysed 855 patients in the DD-US-CT group and 838 in the DD-CT group per protocol. The 3-month thromboembolic risk was 0.3% (95% CI 0.1-1.1) in the DD-US-CT group and 0.3% (0.1-1.2) in the DD-CT group (difference 0.0% [-0.9 to 0.8]). In the DD-US-CT group, ultrasonography showed a deep-venous thrombosis in 53 (9% [7-12]) of 574 patients, and thus MSCT was not undertaken. The strategy combining D-dimer and MSCT is as safe as the strategy using D-dimer followed by venous compression ultrasonography of the leg and MSCT for exclusion of pulmonary embolism. An ultrasound could be of use in patients with a contraindication to CT.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pan Afr Med J
                Journal ID (iso-abbrev): Pan Afr Med J
                Journal ID (publisher-id): PAMJ
                Title: The Pan African Medical Journal
                Publisher: The African Field Epidemiology Network
                ISSN (Electronic): 1937-8688
                Publication date (Electronic): 03 June 2019
                Publication date Collection: 2019
                Volume: 33
                Electronic Location Identifier: 75
                Affiliations
                [1 ]Service de Cardiologie, CHU Mohammed VI, Faculté de Médecine, Université Mohammed Premier, Oujda, Maroc
                Author notes
                [& ]Auteur correspondant: Houssam Laachach, Service de Cardiologie, CHU Mohammed VI, Faculté de Médecine, Université Mohammed Premier, Oujda, Maroc
                Article
                Publisher ID: PAMJ-33-75
                DOI: 10.11604/pamj.2019.33.75.18355
                PMC ID: 6689829
                SO-VID: d712b3c3-f893-4306-b959-085db316b0f4
                Copyright © © Fadoua Mouedder et al.
                License:

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 February 2019
                Date accepted : 21 February 2019
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: embolie pulmonaire,syndrome coronaire aigu,troponine,pulmonary embolism,severe coronary syndrome,troponin
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: embolie pulmonaire, syndrome coronaire aigu, troponine, pulmonary embolism, severe coronary syndrome, troponin

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