Chronic Thromboembolic Pulmonary Hypertension

Papamatheakis, Demosthenes G.; Poch, David; Fernandes, Timothy; Kerr, Kim M.; Kim, Nick H.; Fedullo, Peter F.

doi:10.1016/j.jacc.2020.08.074

Cited by 61 publications

(64 citation statements)

References 107 publications

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“…In the case of an abnormal perfusion scan, a high-quality pulmonary angiogram is necessary to confirm and define the pulmonary vascular involvement and prior to making a treatment decision. Its management principles are [66][67][68][69][70][71][72][73] Multi-centre data suggested that the use of DOAC therapy resulted in a higher incidence of PTE recurrence compared with VKA without any survival difference.…”

Section: Management Of Ctephmentioning

confidence: 99%

Management of Pulmonary Thromboembolism

Kiran¹

2022

Art and Challenges Involved in the Treatment of Ischaemic Damage

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Pulmonary thrombo-embolism (PTE) is a major cause of cardiovascular morbidity and mortality. Incidence of PTE and its associated mortality is affected by the Prescence of associated risk factors, comorbid conditions and advancement in the treatment options. Clinical probability, D-Dimer, echocardiography and CT pulmonary angiography are used in the diagnosis. Management starts with stratification, with high-risk category being benefited from the thrombolytic therapy. Catheter directed therapy may be used in ineligible or failed cases with surgical embolectomy being used as final salvage therapy. Patients with persistent hemodynamic stability can be started on anticoagulation alone. Supportive therapy with fluid expansion and inhalational Nitric oxide may provide benefit in few. Patients with PTE should receive secondary preventive anticoagulation to prevent recurrences. High risk patients with sub-segmental PTE may benefit from anticoagulation. For early detection of long-term complications of PTE a patient cantered follow-up is needed. Chronic thrombo-embolic pulmonary hypertension (CTEPH) is a dreaded complication with pulmonary end-arterectomy being a gold standard management option in eligible patients with non-surgical therapy (balloon pulmonary angioplasty and pulmonary vasodilators) also being used in many cases.

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Section: Management Of Ctephmentioning

confidence: 99%

Management of Pulmonary Thromboembolism

Kiran¹

2022

Art and Challenges Involved in the Treatment of Ischaemic Damage

View full text Add to dashboard Cite

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“…The multi-step-diagnostic approach includes a high index of suspicion in those with symptoms of dyspnea and/or exercise intolerance after a history of VTE (PE and DVT), measuring pulmonary pressure, and identifying lung clots which can be achieved using a diagnostic algorithm [ 133 ]. Some CTEPH diagnostic modalities include echocardiography, pulmonary function testing, ventilation/perfusion (V/Q) scanning, CT pulmonary angiography (CTPA), right heart catheterization (RHC), and contrast pulmonary angiography [ 134 - 135 ]. Pulmonary thromboendarterectomy (PTE) sometimes referred to as pulmonary endarterectomy (PEA) is currently effective and curative treatment for CTEPH [ 136 ].…”

Section: Reviewmentioning

confidence: 99%

Deep Vein Thrombosis in Intravenous Drug Users: An Invisible Global Health Burden

Jain¹,

Avanthika²,

Singh³

et al. 2021

Cureus

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The prevalence of intravenous drug use has increased in the past decade and it represents an important risk factor for deep vein thrombosis. Intravenous drug use is a global problem, with the main culprit being heroin. Peer pressure and poverty in high-risk groups such as sex workers, females, and young adults raise the risk of intravenous drug use, which expresses itself in the form of venous thromboembolism eventually. Deep vein thrombosis typically manifests itself eight years after the initial intravenous drug administration, rendering it a silent killer.Aiming to review and summarize existing articles in this context, we performed an exhaustive literature search online on PubMed and Google Scholar indexes using the keywords "Deep Venous Thrombosis (DVT)" and "Intravenous Drug Users (IVDU)." English articles that addressed epidemiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, management, and outcomes of DVT, including those in IVDU, were selected and analyzed.The pathogenesis of DVT development in IVDU is mainly attributed to the interplay of trauma to the vessel by repeated injection and the injected drug itself. The right-sided femoral vein is the most common vein affected. Prevalent clinical presentations include local pain, swelling, and redness with typical systemic symptoms including fever, cough, dyspnea, and chest pain on top of addiction features. There appeared to be a delay in reporting symptoms, which was most likely due to the social stigma attached to IVDU.There are over 50 conditions that present with swollen and painful limbs comparable to DVT in IVDU, making precise diagnosis critical for timely treatment. Venous ultrasound is the method of choice for diagnosing DVT. Extended anticoagulant therapy with low-molecular-weight heparin combined with warfarin is the recommended treatment. Intravenous drug abusers having DVT are affected by multiple complications and poorer outcomes such as slower recovery, recurrent venous thromboembolism (VTE), and a longer hospital stay, which put them at higher risk of morbidity, mortality, reduced productivity, and economic burden.

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“…Hemoptysis may occur and is likely related to bronchial artery collateral circulation. With disease progression, a murmur of tricuspid regurgitation, an RV lift or gallop, fixed splitting of S2, elevated jugular venous pressure, hepatojugular reflux, ascites, hepatomegaly and peripheral edema may be noted (5). Left untreated, patients will develop severe functional limitations and will have a poor quality of life and survival (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%