A 71-year-old man with COPD and cor pulmonale presents with acute dyspnea and syncope. Chest X-ray shows cardiomegaly and pulmonary congestion. Arterial blood gas reveals PaO2 55 mmHg, PaCO2 65 mmHg on 2L oxygen. D-dimer is markedly elevated. Which of the following is the most accurate statement regarding PE diagnosis in this patient?
- A)Syncope in COPD patients always indicates cor pulmonale decompensation
- B)Elevated D-dimer excludes PE and suggests acute COPD exacerbation
- C)Clinical suspicion for PE is high despite overlapping respiratory disease; CTPA is indicatedGABARITO
- D)Hypercapnia excludes PE as a diagnosis
- E)High pretest probability rules out need for confirmatory imaging
Explicação
PE can coexist with COPD exacerbation and cor pulmonale. Syncope is a sign of acute hemodynamic compromise (massive PE) that warrants investigation. D-dimer is elevated in both conditions but does not differentiate them. CTPA is necessary to confirm or exclude... Ver explicação completa e trilha adaptativa →