1. Student’s Research Group at the Department of Internal Medicine, Hypertension and Angiology The Medical University in Warsaw PULMONARY EMBOLISM – TOUGH DIAGNOSTIC PROBLEM Andrzej Łabyk, Anna Kalbarczyk, Agata Piaszczyk Scientific supervisor: dr n. med. Maciej Kostrubiec

2. Introduction The mortality of untreated PE is estimated at approximately 30% of patients, whereas treatment decreases death rate to 2 – 8% The specific combination of symptoms which occur in PE may suggest an improper diagnoses of other cardiac or lung disorders

3. Objective To evaluate frequencies of clinical symptoms and changes in diagnostic investigations, which can mislead to the recognition of acute coronary syndrome (ACS) or lung diseases (Ld) in PE patients

4. Material Group characteristic 154 inpatients with recognized acute pulmonary embolism Mean age 62 ± 17 years (21 – 91) M = 65 (42%) F = 89 (58%)

5. Methods Recognition proved by high probability lung scan or in spiral CT All treated in the Department of Internal Medicine, Hypertension and Angiology in CSK AM in Warsaw

6. Methods Analysed information and Division criteria Chest pain Ischaemic changes on ECG Elevated cardiac troponin level ≥2 symptoms - acute coronary syndrome (ACS) group Fever Dyspnea Cough Lung consolidations in X-ray/CT ≥2 symptoms - lung diseases (Ld) group

7. Methods Analysed information in both groups: Coronary artery disease (CAD) Heart failure (HF) Chronic obstructive pulmonary disease (COPD) Atrial fibrilation (AF) on ECG Right bundle-branch block (RBBB) on ECG

8. Results n=154 pts

9. Results Groups characteristic AllACSLdOverlap 154pts19%24%19% chest pain48%66%38%72% dyspnea91%97%89%93% fever12%0%24%26% cough30%0%56%60% haemoptysis10% 11%8% CT/X-ray33%8%76%67% ECG changes 52%93%31%93%

10. Comparison of ACS group with others

11. Comparison of Ld group with others p=ns

12. Comparison of Overlap group with others p=ns

13. Results Troponin elevation * patients with chest pain AND ECG changes * n=14 n=27 n=10 n=31 cTnI > 0.1 ng/ml

14. Conclusions In most patients with final diagnosis of pulmonary embolism the presented symptoms and investigation results on admission can mislead to the recognition of acute coronary syndrom or lung disease The chest pain and ischemic changes on ECG are frequently associated with the myocardial injury resulting in the increase of troponin level in PE patients