Acute and chronic pulmonary thromboembolism: current perspectives part viii: summaRy and references

Abstract

SummaryDespite considerable strides which have been made both in diagnosis and in management of PTE, both acute and chronic, it remains a significant challenging problem even to the most astute clinician. In approximately 50% of patients who suffer from acute fatal PTE the disease is not diagnosed as such during life.Accurate diagnosis of PTE requires a high index of suspicion, particularly in patients who have one or more predisposing factors (e.g., prolonged immobilization, obesity, trauma, postoperative state, advanced age, congestive heart failure, malignancy, pregnancy, postpartum state, and coagulation disorders such as antithrombin I11 deficiency and protein C deficiency).Despite the wide array of nonspecific and protean manifestations of acute PTE, the history and physical examination still constitute the first basis for suspecting the diagnosis. Dyspnea occurs in over 90% of the patients and the triad of dyspnea, tachypnea, and pleuritic pain is present in 70%. The combination of dyspnea, tachypnea, and DVT occurs in 99% of the patients. Conversely, in the absence of these symptoms and signs, the diagnosis of PTE is unlikely. Certain atypical manifestations which have recently been emphasized in acute PTE are high fever, abdominal pain, disseminated intravascular coagulation, and acute bronchospasm simulating bronchial asthma. Syncope, cardiovascular collapse, cyanosis, right ventricular S3 or S4, and loud P2 suggest probability of acute massive PTE.Following the history and physical examination, chest roentgenogram, electrocardiogram, and arterial blood gas analysis should be performed to exclude other diagnoses which can mimic acute PTE (e.g., pneumonia, coronary insufficiency, and myocardial infarction). The use of VPS can identify some cases and exclude others but the procedure is usually worthless if significant parenchymal or pleural abnormalities already exist. PA and AV are often needed in many patients in order to establish definitive diagnosis of PTE and DVT, respectively. These studies can be camed out with reasonable safety and have proven to be cost effective when used on proper indications. It should be emphasized that the accurate diagnosis of acute and chronic PTE is necessary not only to insure proper management of patients but also to prevent inappropriate anticoagulation or surgery along with their inherent risks.Primary prophylaxis of DVT in certain high-risk patients referred to above should always be preferred to the treatment of acute PTE. In this respect early ambulation and lowdose heparin have proven very effective. Both are currently used widely in clinical practice with admitted success.The management of acute PTE is directed toward the correction of hemodynamic consequences as well as the prevention of further recurrences. The basic program consists of administering heparin intravenously, either by bolus or by continuous infusion, preferably the latter, for 7-10 days, followed by long-term anticoagulation for 4 months following an acute episode in a patient with no existing ...

Measurement of dehydrogenase activity in hepatocytes in massive pulmonary embolism

“…In light of this, changes in the heart and pulmonary vessels are extensively studied [2,7,9]. However, other organs are also altered in MPE, in particular, liver dysfunction plays an important role in the pathogenesis of postembolization syndrome.…”