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Taipei City Hospital


Chronic Chest Distress and Dyspnea May Be Caused by Pulmonary Embolism

An 88-year-old woman had previously suffered from hypertension and cardiac arrhythmia, without obvious chest distress and dyspnea. Since her eldest daughter, who had lived with her, passed away in March, she had been upset and experienced chest distress throughout the day when moving around or resting. The symptoms did not improve, so she was sent to hospital for emergency treatment in early May. Blood tests showed that the level of D-dimer, the product of thrombolysis, was higher, while the oxygen saturation had decreased, suggesting hypoxia. After pneumonia and pleural effusion were excluded, pulmonary thrombosis was suspected. The CT angiography of the lungs showed a right upper pulmonary embolism, and the symptoms improved gradually after the administration of anticoagulant.
Du Ming-Huang, attending physician of the Department of Chest Medicine in the Zhongxing Branch of Taipei City Hospital, says that pulmonary embolism is caused by venous drainage, which results in the formation of embolisms of different sizes owing to disturbed flow or greater blood viscosity. Blood vessels then become blocked, resulting in pulmonary vascular hypoperfusion. The main role of the lungs is to complete gas exchange by means of ventilation and blood perfusion. The aggravated failure of blood perfusion will not provide sufficient oxygenated blood to flow back to the left heart for use by the cells of the whole body. Therefore, patients will experience the dyspnea sensation due to hypoxia.
Pulmonary embolism, which does not cause hemodynamic instability, is mainly treated by anticoagulants, with the course of treatment lasting 3 to 6 months. When the pulmonary embolism results in severe right heart failure, the use of a thrombolytic agent or surgical embolectomy should be considered.
Dr. Du notes that chronic chest distress and shortness of breath from unknown causes should be treated as soon as possible. Besides common ischemic heart disease, heart failure, chronic obstructive pulmonary disease or asthma should be taken into account, while pulmonary embolism, which will cause severe complications, should also be listed for differential diagnosis.