A case report describing a 65-year-old man presenting with collapse, hypotension, and chest pain, with a differential diagnosis including myocardial infarction or pulmonary embolism.
Initial response to plasma expander does not preclude deterioration; leaves open optimal diagnostic approach in suspected MI or PE.
A 65-year-old man with a past history of hypertension was admitted after collapsing in the street. He complained of chest pain and dizziness following brief loss of consciousness. Two years previously he had suffered a right-sided cerebrovascular accident but had made a good recovery. Examination was normal apart from a systolic blood pressure of 80 mmHg which responded to one unit of plasma expander. Routine biochemical investigations and an electrocardiogram were normal. The initial antero-posterior and lateral chest radiographs are shown in Fig 1. A differential diagnosis of myocardial infarction or pulmonary embolism was made. During the night his condition deteriorated and he complained of further chest pain.
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Nicholson et al. (1988) studied this question.
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