scholarly journals Negative Baseline Imaging Does not Exclude Acute Pulmonary Embolism in Patients with Recurrent Syncopal Episodes and Cardiac Biomarker Elevation

2020 ◽  
Author(s):  
Umut Kocabaş ◽  
Hakan Altay ◽  
Flora Özkalaycı ◽  
Seçkin Pehlivanoğlu
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Cardiac Biomarker ◽  
Mortality And Morbidity ◽  
Vein Thrombosis ◽  
Doppler Ultrasound Imaging ◽  
Uncommon Presentation ◽  
Echocardiographic Examination ◽  
Deep Vein ◽  
Acute Pe

Acute pulmonary embolism (PE) is an important vascular disease with high mortality and morbidity and syncope is an uncommon presentation sign of acute PE. This report presents two cases illustrating acute PE as a cause of recurrent syncopal episodes with elevated cardiac troponin and N-terminal pro-brain natriuretic peptide levels despite normal initial trans-thoracic echocardiographic examination and negative Doppler ultrasound imaging for detection of deep vein thrombosis.

scholarly journals P1267 Negative baseline diagnostic imaging does not exclude pulmonary embolism in patients with reccurrent syncope

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
U Kocabas ◽  
H Altay ◽  
F Ozkalayci ◽  
I Isiklar ◽  
S Pehlivanoglu
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Doppler Ultrasound ◽  
Ultrasound Imaging ◽  
Normal Sinus Rhythm ◽  
Pulmonary Arteries ◽  
Vein Thrombosis ◽  
Normal Sinus ◽  
Doppler Ultrasound Imaging ◽  
Deep Vein

Abstract INTRODUCTION In patients who are admitted to a hospital due to episode of syncope, acute pulmonary embolism (PE) is rarely considered as a possible cause. This report presents two cases illustrating PE as a cause of syncope with elevated cardiac troponin (cTn) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels despite normal echocardiographic examination and negative Doppler ultrasound imaging. Case 1: An 83-year-old woman admitted to the ER due to episodes of recurrent syncopes. According to her anamnesis, she had four episodes of syncopes during last three weeks without chest pain, dyspnea, palpitation or hemoptysis. ECG revealed a normal sinus rhythm with a heart rate of 70 bpm without ischemic changes. Laboratory tests revealed raised levels of cTn and NT-proBNP. Transthoracic echocardiography (TTE) demonstrated preserved left and right ventricular systolic functions without any cardiac chamber enlargement and mild tricuspid regurgitation with a PAP of 35 mmHg. Patient’s pre-test probability for pulmonary embolism was low (Wells’ score < 2) but D-dimer level was elevated. Doppler imaging for detection of deep vein thrombosis was negative. Computed tomography pulmonary angiography (CTPA) showed filling defects in the pulmonary arteries consistent with pulmonary embolism (Panel A). The patient was discharged with rivaroxaban therapy without any complication. Case 2: A 69- year-old woman presented to ER with symptoms of chest pain and recurrent episodes of syncope for the last 2 days. Her medical history revealed hypertension and hyperlipidemia. On admission ECG showed a normal sinus rhythm with a heart rate of 105 bpm and T-wave inversions in inferior leads. Laboratory tests showed elevated levels of cTn and NT-proBNP. TTE demonstrated normal left ventricular systolic function with an ejection fraction of 55% and normal right ventricular function and chamber size with a tricuspid annular plane systolic excursion of 22 mm. Diagnostic coronary angiography was performed to exclude acute ischemia revealed non-significant coronary artery stenosis. Doppler ultrasound imaging for detection of deep vein thrombosis was negative. CTPA showed filling defects in the bilateral main pulmonary arteries consistent with acute bilateral pulmonary embolism (Panel B-C). The patient was discharged with rivaroxaban therapy after four days of hospitalization period without any complication. CONCLUSION Elevated cTn and NT-proBNP leves on admission strongly suggest transient hemodynamic impairment causing cardiac injury and syncope. Normal admission ECG and TTE can exclude most possible acute cardiac causes of syncope. Although acute right ventricular dsyfunction is the most frequent finding of acute massive PE causing hemodymanic impairment resulting with syncope, diagnosis of acute PE should only be excluded with CTPA in patients with similar clinical characteristics despite normal TTE and negative venous Doppler ultrasound imaging. Abstract P1267 Figure

Clinical Assessment of Fondaparinux for Treatment of Acute Pulmonary Embolism and Acute Deep Vein Thrombosis in Japanese Patients

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 409A ◽  
Author(s):  
Mashio Nakamura ◽  
Yoshiaki Okano ◽  
Hiroki Minamigichi ◽  
Hiroshi Tsujimoto ◽  
Hiromu Nakajima ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Clinical Assessment ◽  
Acute Pulmonary Embolism ◽  
Japanese Patients ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Experience in 207 Combined MRI Examinations for Acute Pulmonary Embolism and Deep Vein Thrombosis

2006 ◽  
Vol 186 (6) ◽  
pp. 1686-1696 ◽  
Author(s):  
Alexander Kluge ◽  
Clemens Mueller ◽  
Johannes Strunk ◽  
Uwe Lange ◽  
Georg Bachmann
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Acute Pulmonary Embolism ◽  
Vein Thrombosis ◽  
Deep Vein

scholarly journals Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mukunthan Murthi ◽  
Hafeez Shaka ◽  
Zain El-amir ◽  
Sujitha Velagapudi ◽  
Abdul Jamil ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Acute Pulmonary Embolism ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Medical Problem ◽  
Mortality And Morbidity ◽  
Acute Pe

Abstract Background Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS). Methods In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity‐matched cohort of patients to compare mortality. Results In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78–5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95–3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42–2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08–8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99–3.48, p < 0.001) were also higher for PE patients with hypocalcemia. Conclusion PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.

scholarly journals Current Endovascular Treatment Options in Acute Pulmonary Embolism

2021 ◽  
Vol 11 ◽  
pp. 5
Author(s):  
Kelli Moore ◽  
Jeff Kunin ◽  
Mohammed Alnijoumi ◽  
Prashant Nagpal ◽  
Ambarish P. Bhat
Keyword(s):  
Pulmonary Embolism ◽  
Endovascular Treatment ◽  
Acute Pulmonary Embolism ◽  
Treatment Options ◽  
Mortality And Morbidity ◽  
Response Team ◽  
Promising Treatment ◽  
Level I ◽  
Acute Pe

Acute pulmonary embolism (PE) is a significant cause of mortality and morbidity across the globe. Over the last few decades, there have been major therapeutic advances in acute PE management, including catheter-based therapy. However, the effectiveness of catheter-based therapy in acute PE is not supported by Level I evidence, making the use of this promising treatment rather controversial and ambiguous. In this paper, we discuss the risk stratification of acute PE and review the medical and endovascular treatment options. We also summarize and review the data supporting the use of endovascular treatment options in acute PE and describe the potential role of the PE response team.

scholarly journals Acute pulmonary embolism complicating deep vein thrombosis in a young patient with stroke

2021 ◽  
Vol 11 (2) ◽  
pp. 142-144
Author(s):  
Mohammed Mirazur Rahman ◽  
Farjana Binte Habib ◽  
Ahmed Imran Kabir ◽  
Samprity Islam ◽  
Rajashish Chakrabortty ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Acute Pulmonary Embolism ◽  
Successful Outcome ◽  
Shortness Of Breath ◽  
Vein Thrombosis ◽  
Doppler Study ◽  
Left Lower Limb ◽  
Deep Vein

Acute pulmonary embolism is one of the most common causes of vascular death after myocardial infarction and cerebrovascular accidents. It usually presents with severe chest pain and shortness of breath and occasionally occurs in the background of deep vein thrombosis. A 32-year-old male presented with swelling of left lower limb and shortness of breath. Subsequent investigations revealed that he developed DVT of left lower limb and pulmonary embolism. However, in general, if left untreated, pulmonary embolism is associated with an overall mortality of up to 30 percent compared with 2 to 11 percent in those treated with anticoagulation. Early diagnosis by D-dimer, computed tomograpgy pulmonary angiogram and doppler study of the left lower limb and prompt intervention through low molecular weight heparin and rivaroxaban led to a successful outcome in our case. Birdem Med J 2021; 11(2): 142-144

scholarly journals Acute Pulmonary Embolism Post COVID-19 Pneumonia – A Case Report

2021 ◽  
pp. 315-318
Author(s):  
M. Nitharsha Prakash ◽  
N. N. Anand ◽  
Karthick Ramalingam ◽  
G. Venkat Sai
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Thromboembolism ◽  
Evidence Based ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Coagulation Therapy ◽  
Thromboembolism Events ◽  
Deep Vein

COVID-19 has been associated with multiple venous thromboembolism events such as pulmonary embolism and deep vein thrombosis. Here we report a 64-year male with COVID-19 pneumonia who developed pulmonary thromboembolism following the COVID illness. This patient developed VTE complication in spite of receiving anti-coagulation therapy during admission. This case brings out the need for evidence-based post-discharge VTE prophylaxis approach and guidelines in patients who recover from COVID-19.

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.

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