Acute Pulmonary Embolism: Presentation, Diagnosis, Management and Factors Impacting Clinical Outcome in a Tertiary Cardiac Centre in Pakistan
| Autor: | Shabana Kausar, Azhar Mahmood Kayani, Adeel-Ur-Rehman, Hamid Sharif Khan, Muhammad Talha Bin Nazir |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Streptokinase medicine.medical_treatment Diagnosis Differential Recurrence Medicine Humans Pakistan Thrombolytic Therapy Adverse effect Aged Aged 80 and over Univariate analysis business.industry Tertiary Healthcare Warfarin Cancer Anticoagulants General Medicine Thrombolysis Middle Aged medicine.disease Surgery Pulmonary embolism Shock (circulatory) Acute Disease Female medicine.symptom business Pulmonary Embolism medicine.drug |
| Zdroj: | Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 29(8) |
| ISSN: | 1681-7168 |
| Popis: | Objective To evaluate the presentation, diagnosis, management and outcome of acute pulmonary embolism for assessing the factors impacting mortality in such patients. Study design Descriptive study. Place and duration of study Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan, from July 2015 to July 2018. Methodology Patients presenting with clinical suspicion of pulmonary embolism were subjected to a diagnostic algorithm consisting of Wells Rule, D-Dimer testing, echocardiography and CT pulmonary angiogram. Patients diagnosed with pulmonary embolism were subdivided into massive and submassive pulmonary embolism groups. Most patients diagnosed with massive pulmonary embolism were treated with streptokinase injection. For those diagnosed as submassive pulmonary embolism, the standard therapy remained anticoagulation with intravenous heparin, both the subsets of patients were further put on oral warfarin. Clinical outcome was defined as combined end-point including death during hospital stay, recurrence of PE and meed for repeat thrombolysis. Results A total of 174 patients diagnosed with pulmonary embolism were studied. The mean age was 49.1 +14.8 years (range 23-88 years) with 109 (62.6%) patients being male. The in-hospital clinical course was uneventful in 144 (83%) patients. Twenty-two patients (12.6%) patients died, of whom 3 died from major bleeding, one from cancer, and 18 from the pulmonary embolism process (14 patients from refractory shock and 4 patients from recurrent PE). A total of 8 (4.6%) had fatal or non-fatal recurrent PE. In patients who had echocardiography both pre- and post-thrombolysis, initial RV dysfunction was reversible in 136 (78%) within 48h following thrombolytic therapy. By univariate analysis, only shock (SBP) and delay in diagnosis for more than 6 hours were associated with adverse event. Conclusion Early diagnosis by doing urgent CTPA in patients with suspected acute PE is the cornerstone in reducing mortality in acute PE patients. |
| Databáze: | OpenAIRE |
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