Stroke and refractory hypoxaemia: complications of pulmonary embolism

2021 ◽  
Vol 14 (9) ◽  
pp. e244284
Author(s):  
Mafalda Sá Pereira ◽  
Rita Homem ◽  
Tiago Judas ◽  
Francisca Delerue
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Multidisciplinary Approach ◽  
Foramen Ovale ◽  
History Of Surgery ◽  
History Of

Acute pulmonary embolism is one of the main causes of cardiovascular mortality. Treatment should be guided according to mortality risk stratification, but an individualised and multidisciplinary approach is often required. Concomitant persistent hypoxaemia can be present in cases of intracardiac shunt. In this report, we describe a 46-year-old woman with a history of surgery, presenting with pulmonary embolism with refractory hypoxaemia and simultaneous ischaemic stroke. Fibrinolysis was successfully performed, and the patient made a full recovery. Additional investigations identified a patent foramen ovale, which was later closed. She had no recurrent thrombotic events.

scholarly journals Acute pulmonary embolism and patent foramen ovale - neglected risk association

Cor et Vasa ◽  
2011 ◽  
Vol 53 (6-7) ◽  
pp. 348-352 ◽  
Author(s):  
Martin Hutyra ◽  
David Vindiš ◽  
Daniel Šaňák ◽  
Tomáš Skála
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Foramen Ovale ◽  
Risk Association

scholarly journals Acute Pulmonary Embolism and Paradoxical Embolism in Patients with Patent Foramen Ovale: to Close or Not to Close…That is the Question!

2017 ◽  
Vol 11 ◽  
Author(s):  
Marco Zuin ◽  
Gianluca Rigatelli
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Randomized Trials ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
International Guidelines ◽  
Acute Pe

<p>Nowadays, the treatment of patent foramen ovale (PFO) after acute pulmonary embolism (PE) remains matter of speculation. Absence of both randomized trials and recommendations in current international guidelines complicate the decisions making in such patients. In the present manuscript we discuss about the reasons for which PFO should be closed after acute PE.</p>

scholarly journals Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

Open Medicine ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 10-13
Author(s):  
Junko Yamaguchi ◽  
Akihiro Noda ◽  
Akira Utagawa ◽  
Atsushi Sakurai ◽  
Kosaku Kinoshita
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Cerebral Embolism ◽  
Foramen Ovale ◽  
Pediatric Case ◽  
Pediatric Critical Care ◽  
Vein Thrombosis ◽  
Side Pressure ◽  
Deep Vein

AbstractHerein, we report a pediatric case of acute paradoxical cerebral embolism complicated by serious acute pulmonary embolism that was caused by an extremely small patent foramen ovale (PFO). The patient had no medical history suggestive of any other reason.Paradoxical cerebral embolism may occur even with an extremely small PFO because of the increased right-side pressure of the heart and a resulting right-to-left shunt from the acute pulmonary embolism. Although pediatric cases of pulmonary embolism are rare, when diagnosed, clinicians should consider the risk of a concurrent paradoxical cerebral embolism resulting from a latent PFO. The possibility of PFO should be assessed extremely carefully in pediatric critical care by checking for a thrombogenesis tendency and the existence of deep vein thrombosis in the patient.

Pathophysiology of acute pulmonary embolism

ESC CardioMed ◽  
2018 ◽  
pp. 2756-2758
Author(s):  
Dieuwertje Ruigrok ◽  
Anton Vonk Noordegraaf
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Vascular Occlusion ◽  
The Other ◽  
Mechanical Obstruction ◽  
Foramen Ovale ◽  
Compensatory Mechanisms ◽  
Acute Increase ◽  
The Right

Acute right ventricular (RV) failure and impaired gas exchange (mainly hypoxaemia) can be two important issues clinicians are confronted with in patients with acute pulmonary embolism. An acute increase in RV afterload due to mechanical obstruction and vasoconstriction is the crucial factor starting a cascade with compensatory mechanisms, RV dilatation, RV ischaemia, and inflammation ultimately leading to RV dysfunction/failure. On the other hand, vascular occlusion leads to redistribution of pulmonary perfusion to regions with relative overperfusion causing profound hypoxaemia. Less commonly, shunting occurs due to atelectasis or due to opening of a patent foramen ovale, causing refractory hypoxaemia. Understanding these mechanisms is crucial in making the right treatment decisions when faced with a patient with acute pulmonary embolism and haemodynamic or respiratory instability.

scholarly journals A NEW ELECTROCARDIOGRAPHIC SCORE (CRAST-PE) FOR MORTALITY RISK STRATIFICATION OF PATIENTS WITH ACUTE PULMONARY EMBOLISM

2020 ◽  
Vol 75 (11) ◽  
pp. 2073
Author(s):  
Baris Bugan ◽  
Elif Ijlal Cekirdekci ◽  
Erkan Yildirim ◽  
Cagatay Onar ◽  
Uygar Yuksel
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Mortality Risk ◽  
Acute Pulmonary Embolism

scholarly journals Assessment of Renal Dysfunction Improves the Simplified Pulmonary Embolism Severity Index (sPESI) for Risk Stratification in Patients with Acute Pulmonary Embolism

2019 ◽  
Vol 8 (2) ◽  
pp. 160
Author(s):  
Antonin Trimaille ◽  
Benjamin Marchandot ◽  
Mélanie Girardey ◽  
Clotilde Muller ◽  
Han Lim ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Renal Dysfunction ◽  
Cardiovascular Mortality ◽  
Acute Pulmonary Embolism ◽  
Kidney Injury ◽  
Severity Index ◽  
Reactive Protein ◽  
Specific Subset ◽  
Overall Mortality

Background: Whereas the major strength of the simplified pulmonary embolism severity index (sPESI) lies in ruling out an adverse outcome in patients with sPESI of 0, the accuracy of sPESI ≥ 1 in risk assessment remains questionable. In acute pulmonary embolism (APE), the estimated glomerular filtration rate (eGFR) can be viewed as an integrate marker reflecting not only previous chronic kidney disease (CKD) damage but also comorbid conditions and hemodynamic disturbances associated with APE. We sought to determine whether renal dysfunction assessment by eGFR improves the sPESI score risk stratification in patients with APE. Methods: 678 consecutive patients with APE were prospectively enrolled. Renal dysfunction (RD) at diagnosis of APE was defined by eGFR < 60 mL/min/1.73 m2 and acute kidney injury (AKI) by elevation of creatinine level >25% during in-hospital stay. Results: RD was observed in 26.9% of the cohort. AKI occurred in 18.8%. A stepwise increase in 30-day mortality, cardiovascular mortality and overall mortality was evident with declining renal function. Multivariate analysis identified RD and CRP (C-reactive protein) level but not sPESI score as independent predictors of 30-day mortality. AKI, 30-day mortality, overall mortality, and cardiovascular mortality were at their highest level in patients with eGFR < 60 mL/min/1.73 m2 and sPESI ≥1. Conclusion: in patients with APE, the addition of RD to the sPESI score identifies a specific subset of patients at very high mortality.

scholarly journals Perioperative Acute Pulmonary Embolism: A Concise Review with Emphasis on Multidisciplinary Approach

2020 ◽  
Vol 29 (03) ◽  
pp. 183-188
Author(s):  
Mateo Porres-Aguilar ◽  
Belinda N. Rivera-Lebron ◽  
Javier E. Anaya-Ayala ◽  
María Cristina Guerrero de León ◽  
Debabrata Mukherjee
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Therapeutic Approach ◽  
Acute Pulmonary Embolism ◽  
Multidisciplinary Approach ◽  
Rare Complication ◽  
Concise Review ◽  
Key Concepts ◽  
Intraoperative Period

AbstractPerioperative acute pulmonary embolism represents a relatively rare complication; however, it could be very serious and devastating in some cases. Its diagnosis could be particularly challenging, especially in the intraoperative period. Herein, we emphasize some key concepts with the aim to perform an early and appropriate risk stratification, diagnostic and therapeutic approach in a multidisciplinary fashion, a brief overview on thromboprophylaxis, with the main objective to improve outcomes and survival in these challenging patients.

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