A Rare Case of Pulmonary Embolism: A Case Report

Pulmonary embolism in an old patient with a history of coagulation disorder, any recent major surgeries or in a chronic heart or lung diseases is widely reported. Also, a recent history of travel by air with flight distance of more than 5000km or BMI greater than 35 kg/m2 increase risk. However, we report here, a suggestive case of acute pulmonary embolism in a previously well male of 38 years, with a BMI of 25.71kg/m2 without any history of chronic illness or acute exacerbations. The patient presented in health facility with sudden onset of radiating chest pain and some other nonspecific symptoms. Neither any other significant personal risk factors except smoking, nor any family history of heart/lung diseases were ruled out during initial assessments. On investigations, other routine examinations were normal but T-wave inversion was noticed in lead V1-4 in ECG, Troponin-I was positive and CPK-MB was slightly elevated (27 U/L). Furthermore, no any remarkable changes were noticed in Chest X-ray. Then, the patient was referred to higher center with cardiac facility with provisional diagnosis of Acute Coronary Syndrome for further evaluation and management. Thereupon, Coronary Angiogram (CAG) was done and the report was normal but echocardiography findings were suggestive of pulmonary Embolism. D-dimer was also elevated (8279.05 ng/ml) but venous doppler study of bilateral lower limb was normal. Finally, CT-PA showed partially occluding thrombus in main pulmonary bifurcation extending into left and right pulmonary artery, its bilateral segmental branches and calcified granuloma was seen in right lobe of liver. Patient was under inj. LMWH and other supportive management during hospitalization. After an uneventful hospital stay for 12 days, general condition was improved and eventually, patient was discharged, with oral warfarin. Keywords: chest pain; Nepal; pulmonary embolism; risk factors.

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Case Report: Unprovoked venous thromboembolism in a young adult

F1000Research ◽

10.12688/f1000research.18202.1 ◽

2019 ◽

Vol 8 ◽

pp. 182

Author(s):

Jeyhan Dhabhar ◽

Varshil Mehta ◽

Nimit Desai ◽

Sameer Dawoodi ◽

Sojib Bin Zaman

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Trauma Surgery ◽

Sudden Onset ◽

Vein Thrombosis ◽

Doppler Study ◽

Pulmonary Angiogram ◽

Co Morbidity ◽

History Of ◽

Prolonged Immobilization

A 24-year-old male was presented to us with sudden onset of chest pain and dyspnea for the past one hour. There was no history of calf pain, trauma, surgery, prolonged immobilization, long-haul air travel, bleeding diathesis or any other co-morbidity. The patient denied any addiction history. The Electrocardiogram showed tachycardia with S1Q3T3 pattern. The left arterio-venous Doppler study was suggestive of a thrombus in popliteal vein and sapheno-popliteal junction. The CT-Pulmonary Angiogram scan was suggestive of a massive pulmonary thromboembolism. The patient was thrombolysed with Intravenous Alteplase immediately and was put on tab Rivaroxaban for maintenance. He was later discharged after being stable. Unprovoked venous thromboembolism (VTE) is very rare and has the potential to lead to pulmonary embolism which could be disastrous, especially in young adults. We present such a case where unprovoked VTE was diagnosed and treated. This case suggests that high clinical suspicion is the key for the diagnosis of acute pulmonary embolism, especially in the absence of history suggestive of deep vein thrombosis.

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Case Report: Unprovoked venous thromboembolism in a young adult male

F1000Research ◽

10.12688/f1000research.18202.2 ◽

2019 ◽

Vol 8 ◽

pp. 182

Author(s):

Jeyhan Dhabhar ◽

Varshil Mehta ◽

Nimit Desai ◽

Sameer Dawoodi ◽

Sojib Bin Zaman

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Trauma Surgery ◽

Sudden Onset ◽

Vein Thrombosis ◽

Doppler Study ◽

Pulmonary Angiogram ◽

Co Morbidity ◽

History Of ◽

Prolonged Immobilization

A 24-year-old male was presented to us with sudden onset of chest pain and dyspnea for the past one hour. There was no history of calf pain, trauma, surgery, prolonged immobilization, long-haul air travel, bleeding diathesis or any other co-morbidity. The patient denied any addiction history. The heart rate was 114 beats/min, and blood pressure was 106/90 mmHg. Electrocardiogram showed tachycardia with S 1Q 3T 3 pattern. The left arterio-venous Doppler study was suggestive of a thrombus in popliteal vein and sapheno-popliteal junction. The CT-Pulmonary Angiogram scan was suggestive of a massive pulmonary thromboembolism. The patient was thrombolysed with Intravenous Alteplase immediately and was put on tab Rivaroxaban for maintenance. He was later discharged after being stable. Unprovoked venous thromboembolism (VTE) is very rare and has the potential to lead to pulmonary embolism which could be disastrous, especially in young adults. We present such a case where unprovoked VTE was diagnosed and treated. This case suggests that high clinical suspicion is the key for the diagnosis of acute pulmonary embolism, especially in the absence of history suggestive of deep vein thrombosis.

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Abstract 157: Use of a Novel Risk Score in the Emergency Department Discriminates Acute Coronary Syndrome Among Chest Pain Patients with Known Coronary Artery Disease

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.157 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Matthew T Crim ◽

Frederick K Korley ◽

Scott A Berkowitz ◽

Mustapha Saheed ◽

Jason Miller ◽

...

Keyword(s):

Coronary Artery Disease ◽

Chronic Kidney Disease ◽

Chest Pain ◽

Risk Score ◽

Troponin I ◽

Elevated Troponin ◽

Ecg Changes ◽

Coronary Syndrome ◽

History Of ◽

Artery Disease

Background: Patients with known coronary artery disease (CAD) presenting to the Emergency Department (ED) with chest pain thought to be of ischemic origin are often admitted to the hospital, yet less than half are eventually diagnosed with acute coronary syndrome (ACS). We assessed whether the use of a novel risk score in the ED could discriminate which of these high-risk patients actually do or do not have ACS. Methods and Results: Chart review was performed on a prospectively defined cohort of 142 patients with known CAD presenting to the ED with chest pain thought to be of ischemic origin, all of whom were admitted to the hospital from December 2012 to April 2013. Known CAD was defined as history of myocardial infarction, PCI, CABG, angiographic coronary stenosis >50%, or a positive stress test. Troponin I was measured using the Beckman Coulter assay. Variables were assessed with logistic regression for their association with ACS as determined by the inpatient attending physician at hospital discharge. The cohort included 59 women (42%) and 90 African American individuals (63%). One-hundred sixteen patients (82%) had a history of revascularization (104 PCI, 53 CABG, 41 both). ACS was eventually diagnosed in 43 (30%) of the patients. Non-ACS patients had a 2.8 day average length of stay and $9,908 average inpatient (post-ED) hospital charges (not including physician fees), which is $980,926 for the 99 (70%) non-ACS patients. A novel risk score, including (1) elevated troponin I (>0.05 ng/mL) in the ED, (2) dynamic ECG changes in the ED, (3) body mass index (BMI), (4) home aspirin use, (5) age older than 65, (6) history of chronic kidney disease (CKD), and (7) associated illness at presentation to the ED (anemia, arrhythmia, hypertension, infection, COPD exacerbation, diabetic ketoacidosis or hyperosmolar hyperglycemic state), discriminated ACS and non-ACS with an area under ROC curve (AUC) of 0.829. In the multi-variable regression, troponin I elevation was the most predictive of ACS (OR 7.22, p <0.001), followed by home aspirin use (OR 6.07, p 0.036), age older than 65 (OR 4.06, p 0.012), dynamic ECG changes (OR 2.68, p 0.046), and BMI (OR 1.09, p 0.008). The presence of an associated illness was associated with decreased likelihood of ACS (OR 0.24, p 0.013), as was CKD (OR 0.17, p 0.008). Conclusions: A novel risk score including elevated troponin I in the ED, dynamic ECG changes in the ED, body mass index, home aspirin use, age older than 65, history of chronic kidney disease, and associated illness at presentation to the ED, is a valuable tool for discriminating between ACS and non-ACS among patients with known CAD presenting to the ED with chest pain. This preliminary analysis provides a foundation for larger and prospective studies for validation. Application of this risk score, along with other clinical factors, may reduce the number of potentially avoidable admissions and associated costs.

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Clinical and electrocardiographic profile of patients presenting with acute coronary syndrome in emergency department in a Tertiary Care Hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.08.4437 ◽

2020 ◽

Vol 27 (08) ◽

pp. 1669-1674

Author(s):

Zahid Mahmood ◽

Tariq Feroze Khawaja ◽

Anjum Iqbal ◽

Abdul Rashid Khan ◽

Naveed Arshad

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Chest Pain ◽

Family History ◽

Troponin T ◽

Base Line ◽

Care Hospital ◽

Blood Samples ◽

Coronary Syndrome ◽

History Of

Objectives: To assess the clinical characteristics and diagnosis of ACS for timely, management and further prevention from coronary events. Study Design: Cross sectional study. Setting: Emergency Department (ED) of Punjab Institute of Cardiology (PIC) Lahore. Period: November 2017 to January 2018. Material & Methods: Included 170 diagnosed patients of ACS of both sexes presenting within approximately four hours of symptoms. At presentation ECG and initial blood samples were taken from all patients for base line and Troponin T estimation. All the patients included in the study were properly examined and complete history was taken. Blood samples of patients for diagnosis of NSTEMI were also drawn at 8hrs of arrival. The patients were categorized into STEMI, NSTEMI and UA on the basis of history, ECG and cardiac Troponin T. Results were analyzed statistically. A p-value ≤ 0.05 was considered statistically significant. Results: A total of 170 patients with established diagnosis of ACS were included. The mean age of the patients was 56 years. There was a very strong male predominance (81.76%). The major modifiable risk factors were hypertension (54.71%) and smoking (35.88%), followed by hyperlipidemia (35.29%) and diabetes (32.35%). A previous history of IHD in patients and family history of IHD were equally present (37.65%). A large proportion of patients belonged to middle class (54.12%) and lower (41.18%). Typical pain chest pain was present in 90% and majority of patients enrolled in this study had a diagnosis of myocardial infarction 77.05% and the remainder had unstable angina. We found a higher percentage of ST elevation MI in the patients with MI (84.73%), majority had anterior AMI. Of all patients, 1.77% expired during hospital stay. Conclusion: The majority of ACS patients in our country are male with STEMI. The major risk factors are hypertension, family history of IHD, smoking, hyperlipidemia and diabetes. 90% patients present with typical chest pain while remaining 10% atypical symptoms which must be of prime consideration to assess ACS.

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Assessing the Performance of a Novel Point-of-Care Qualitative Assay for Early Diagnosis of Acute Coronary Syndrome

Cardiology ◽

10.1159/000511435 ◽

2020 ◽

pp. 1-8

Author(s):

Ronny Alcalai ◽

Boris Varshisky ◽

Ahmad Marhig ◽

David Leibowitz ◽

Larissa Kogan-Boguslavsky ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Troponin I ◽

Point Of Care ◽

Final Diagnosis ◽

Cardiac Biomarkers ◽

Fatty Acid Binding ◽

Coronary Syndrome

Background: Early and accurate diagnosis of acute coronary syndrome (ACS) is essential for initiating lifesaving interventions. In this article, the diagnostic performance of a novel point-of-care rapid assay (SensAheart©) is analyzed. This assay qualitatively determines the presence of 2 cardiac biomarkers troponin I and heart-type fatty acid-binding protein that are present soon after onset of myocardial injury. Methods: We conducted a prospective observational study of consecutive patients who presented to the emergency department with typical chest pain. Simultaneous high-sensitive cardiac troponin T (hs-cTnT) and SensAheart testing was performed upon hospital admission. Diagnostic accuracy was computed using SensAheart or hs-cTnT levels versus the final diagnosis defined as positive/negative. Results: Of 225 patients analyzed, a final diagnosis of ACS was established in 138 patients, 87 individuals diagnosed with nonischemic chest pain. In the overall population, as compared to hs-cTnT, the sensitivity of the initial SensAheart assay was significantly higher (80.4 vs. 63.8%, p = 0.002) whereas specificity was lower (78.6 vs. 95.4%, p = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, p = 0.08). Conclusions: Upon first medical contact, the novel point-of-care rapid SensAheart assay shows a diagnostic performance similar to hs-cTnT. The combination of 2 cardiac biomarkers in the same kit allows for very early detection of myocardial damage. The SensAheart assay is a reliable and practical tool for ruling-in the diagnosis of ACS.

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Identification of Risk Factors to Predict the Occurrences of Relapses in Individuals with Schizophrenia Spectrum Disorder in Iran

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020546 ◽

2021 ◽

Vol 18 (2) ◽

pp. 546

Author(s):

Omran Davarinejad ◽

Tahereh Mohammadi Majd ◽

Farzaneh Golmohammadi ◽

Payam Mohammadi ◽

Farnaz Radmehr ◽

...

Keyword(s):

Risk Factors ◽

Suicide Attempts ◽

Disease Onset ◽

Sudden Onset ◽

Spectrum Disorder ◽

Therapeutic Interventions ◽

Schizophrenia Spectrum Disorder ◽

Schizophrenia Spectrum ◽

History Of ◽

Log Normal

Schizophrenia Spectrum Disorder (SSD) is a chronic psychiatric disorder with a modest treatment outcome. In addition, relapses are commonplace. Here, we sought to identify factors that predict relapse latency and frequency. To this end, we retrospectively analyzed data for individuals with SSD. Medical records of 401 individuals with SSD were analyzed (mean age: 25.51 years; 63.6% males) covering a five-year period. Univariate and multivariate Penalized Likelihood Models with Shared Log-Normal Frailty were used to determine the correlation between discharge time and relapse and to identify risk factors. A total of 683 relapses were observed in males, and 422 relapses in females. The Relapse Hazard Ratio (RHR) decreased with age (RHR = 0.99, CI: (0.98–0.998)) and with participants’ adherence to pharmacological treatment (HR = 0.71, CI: 0.58–0.86). In contrast, RHR increased with a history of suicide attempts (HR = 1.32, CI: 1.09–1.60), and a gradual compared to a sudden onset of disease (HR = 1.45, CI: 1.02–2.05). Gender was not predictive. Data indicate that preventive and therapeutic interventions may be particularly important for individuals who are younger at disease onset, have a history of suicide attempts, have experienced a gradual onset of disease, and have difficulties adhering to medication.

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Chest Pain and Exercise Induced Ischemia with Angiographically Insignificant Coronary Arterial Disease: Clinical Presentation and Follow-Up

University Heart Journal ◽

10.3329/uhj.v6i1.7187 ◽

1970 ◽

Vol 6 (1) ◽

pp. 27-31

Author(s):

Md Khurshed Ahmed ◽

Mohammad Salman ◽

Md Ashraf Uddin Sultan ◽

Md Abu Siddique ◽

KMHS Sirajul Haque ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Chest Pain ◽

Stress Test ◽

Exercise Stress Test ◽

Exercise Stress ◽

Coronary Angiogram ◽

Ecg Changes ◽

History Of

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 15-20%. ECG changes suggestive of myocardial ischemia during exercise also can be demonstrated in this subset of the patients. Total 58 patients (42 females) with mean age 42±7 years who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2005 to December 2009 were evaluated. The patients were recruited on the basis of presence of history of chest pain, with normal resting ECG and ischemia like ECG changes during exercise stress test. 32.8% patients had hypertension and 15.5% were diabetics, 19.0% had dyslipidemia and 6.9% had family history of ischemic heart disease. All the patients were having positive exercise stress test. Angiographic findings showed luminal irregularities in 29.3% patients, 15.5% patients had luminal stenosis less than 30% and rest had normal coronary angiogram. Follow up of the patients after one and six months of angiogram was done. After one month 63.8% patients remained symptomatic and after six months 63.3% patients remained symptomatic despite maximum medical management. The pathophysiology and appropriate management of this subset of the patients still remained a challenge for physicians. Optimum management of cardiovascular risk factors is very important issue in this group of patients.Key words: Angiography; Epicardial coronary arteries; Exercise stress test; Cardiovascular risk factors. DOI: 10.3329/uhj.v6i1.7187University Heart Journal Vol.6(1) 2010 pp.27-31

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Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽

10.1017/s148180350001215x ◽

2010 ◽

Vol 12 (02) ◽

pp. 128-134 ◽

Cited By ~ 7

Author(s):

Erik P. Hess ◽

Jeffrey J. Perry ◽

Pam Ladouceur ◽

George A. Wells ◽

Ian G. Stiell

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Congestive Heart Failure ◽

Chest Pain ◽

Chest Radiography ◽

Clinical Decision ◽

Chest Radiographs ◽

Clinical Decision Rule ◽

Coronary Syndrome ◽

History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

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Metabolic Risk Factors and Outcomes in Acute Coronary Syndrome

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i130349 ◽

2020 ◽

pp. 46-50

Author(s):

Ritu Attri ◽

Harsimran Kaur ◽

Raminderpal Singh Sibia ◽

Mandip Singh Bhatia

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Positive Family History ◽

Developed Countries ◽

P Value ◽

Health Crisis ◽

Female Ratio ◽

Medical College ◽

Coronary Syndrome ◽

History Of

Introduction: CAD is the most common cause of mortality in India. It is a common multifarious public health crisis today and a leading cause of morbidity and mortality in both developing and developed countries. Hence, understanding the predominant risk factors among the Indian population is important. Materials and Methods: This was a hospital based age and sex matched case control study, carried out at Government Medical College and Rajindra Hospital Patiala. A total of 100 patients of Acute coronary syndrome were studied. Patients and controls were enquired about the presence of cardiometabolic risk factors and the significance of association of these risk factors with the occurrence of Acute coronary syndrome was given by p value of <0.05. Results: Majority of the cases were in the age group 61-70 years (32%) with male to female ratio of 1.25:1. Significant association was found between ACS and risk factors like smoking, positive family history of IHD, hypertension, diabetes, dyslipidemia, waist hip ratio and body mass index. Overall, most common outcome of ACS in the present study was NSTEMI (45%) followed by STEMI (35%) followed by Unstable angina (20%). Conclusion: Significant association was found between smoking and occurrence of STEMI and significant association was found between Hypertension and occurrence of NSTEMI.

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ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ

Medical Informatics and Engineering ◽

10.11603/mie.1996-1960.2012.1.173 ◽

2012 ◽

Author(s):

І. К. Чурпій

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Pulmonary Embolism ◽

High Risk ◽

Significant Risk ◽

Female Gender ◽

Electrolyte Composition ◽

Terminal Phase ◽

Phase Flow ◽

History Of

To optimize the therapeutic tactics and improve the treatment of peritonitis on the basis of retrospective analysis there are determined the significant risk factors: female gender, age 60 – 90 years, time to hospitalization for more than 48 hours, a history of myocardial infarction, stroke, cardiac arrhythmia, biliary, fecal and fibrinous purulent exudate, the terminal phase flow, operations with resection of the intestine and postoperative complications such as pulmonary embolism, myocardial infarction, pleurisy, early intestinal obstruction. Changes in the electrolyte composition of blood and lower albumin <35 % of high risk prognostic course of peritonitis that requires immediate correction in the pre-and postoperative periods. The combination of three or more risk factors for various systems, creating a negative outlook for further treatment and the patient's life.

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