Case report An 89-year-old patient with acquired murmur associated with pulmonary embolism Maciej Godycki-Ćwirko, Agnieszka Bratkowska Department of Family and Community Medicine, Medical University of Lodz, Poland Submitted: 25 April 2010 Accepted: 6 July 2010 Arch Med Sci 2011; 7, 5: 902-904 DOI: 10.5114/aoms.2011.25569 Copyright © 2011 Termedia & Banach A b s t r a c t Pulmonary embolism (PE) is the third most common cause of death in hospitalized patients. Diagnosis is often missed because of a non-homogeneous clinical picture. We present a case of an 89-year-old patient with an acquired murmur associated with pulmonary embolism. When examined by a family physician the patient had no symptoms typical for PE. During hospitalization, dyspnoea was exacerbated; a non-productive cough, chest pain and oliguria were observed. Pulmonary embolism was diagnosed, but because of the renal failure diagnosis was not confirmed by angio-CT. Key words: pulmonary embolism, heart murmur, symptoms, diagnosis. Introduction Pulmonary embolism (PE) is obliteration of a pulmonary artery caused by an embolus. Usually this is a detached fragment of a thrombus although alternatives include air embolus, fat embolus, cancer embolus, foreign body or amniotic fluid. Thrombi usually arise in the veins of the pelvis or lower limb, especially following surgery or confinement to bed, although occasionally they can arise in the upper part of the body. Emboli are most frequently localized in the inferior lobe of the lung. Pulmonary embolism is the third most common recorded cause of death in hospitalized patients. Autopsy data on patients who died in the hospital revealed its presence in 60% of cases, but the diagnosis was missed in up to 70% of the cases [1]. In the early 1970s, the incidence of PE in the United States was estimated at 1 case per 1000 persons per year [1]. One report from the USA suggested a frequency of 630,000/year with 50,000-100,000 deaths [2]. However, mortality from PE has decreased in the United States. Analysis of almost 43 million death certificates over 20 years found a 1.3% rate of PE, but the age-adjusted rate of death from PE decreased from 191 per million in 1979 to 94 per million in 1998 [3]. A more recent report from the United Kingdom based on 6,550 newly diagnosed patients in the General Practice Research Database gave an incidence of venous thromboembolism of 74.5 per 100,000 people/year [4]. Pulmonary embolism is more common in adults and its incidence increases steadily with age [5, 6]. In this report, we present an 89-year-old patient who had not presented symptoms that are supposed to be typical for PE. Instead a loud heart murmur was observed, which is not a typical symptom in patients with this condition reported in the literature. Corresponding author: Agnieszka Bratkowska Department of Family and Community Medicine Medical University of Lodz 20 Kopcinskiego 90-153 Lodz, Poland Phone: +48 42 679 55 46 Fax: +48 42 678 60 41 E-mail: lusia310@op.pl