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The Pan African Medical Journal 2019The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic... (Review)
Review
The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.
Topics: Adult; Chest Pain; Computed Tomography Angiography; Diagnosis, Differential; Echocardiography; Female; Humans; Myocardial Infarction; Pulmonary Embolism
PubMed: 31692844
DOI: 10.11604/pamj.2019.33.275.18517 -
Clinics and Practice Sep 2020Catastrophic thrombotic syndrome, otherwise known as thrombotic storm (TS) is an extreme prothrombotic clinical syndrome that presents as rapid onset of multiple...
Catastrophic thrombotic syndrome, otherwise known as thrombotic storm (TS) is an extreme prothrombotic clinical syndrome that presents as rapid onset of multiple thromboembolic events affecting a large variety of vasculature. In recent studies, there has been a correlation of high plasma levels of factor VIII with thrombotic events. We present the case of a young man who exhibited multi-organ failure due to thrombotic storm. A 38-year-old male presented to the emergency department for progressive dyspnea and was diagnosed to have pulmonary embolism. The patient developed respiratory distress requiring intubation and was diagnosed with both an ST-elevation myocardial infarction and right cerebral infarction during the hospital course. The patient expired and autopsy revealed the cause of death to be myocardial, cerebral and renal infarction from widespread vascular thrombosis. Autopsy revealed cause of death to be elevated factor VIII associated thrombotic coagulopathy. Factor VIII level upon autopsy was 375% (55-200%). Although TS is rare, it can be lifethreatening if not recognized early. Survival depends on the prompt initiation and duration of anticoagulation.
PubMed: 32952985
DOI: 10.4081/cp.2020.1265 -
JA Clinical Reports Sep 2020Pulmonary vein thrombosis (PVT) and cerebral infarction are rare but critical complications after video-assisted thoracic surgery (VATS).
BACKGROUND
Pulmonary vein thrombosis (PVT) and cerebral infarction are rare but critical complications after video-assisted thoracic surgery (VATS).
CASE PRESENTATION
We experienced two cases of massive middle cerebral artery infarction after VATS for the left upper lobe. Although the precise source of their embolus was never identified, both cases were clinically suspected PVT. Unfortunately, case 2 died because of progressive cerebral herniation. We decided to perform contrast-enhanced computed tomography routinely after VATS for the left upper lobectomy (VATS-LUL) after these cases. Case 3, a 79-year-old female patient, underwent VATS-LUL for lung cancer. She developed PVT in the stump of the left upper pulmonary vein on postoperative day 4. Anti-coagulation therapy was begun immediately and continued for 3 months. She was free of complications 7 months after the operation.
CONCLUSION
PVT and cerebral infarction may occur after VATS-LUL. Appropriate postoperative management is required to recognize PVT and to prevent life-threatening stroke.
PubMed: 32930910
DOI: 10.1186/s40981-020-00378-9 -
Indian Heart Journal 2021Heart failure complicating acute myocardial infarction marks an ominous prognosis. Killip and Kimball's classification of heart failure remains a useful tool in these...
BACKGROUND
Heart failure complicating acute myocardial infarction marks an ominous prognosis. Killip and Kimball's classification of heart failure remains a useful tool in these patients. Lung ultrasound can detect pulmonary congestion but its usefulness in this scenario is unknown.
OBJECTIVE
To investigate the diagnostic accuracy of lung ultrasound to predict heart failure in patients with acute myocardial infarction.
METHODS
Patients admitted with acute myocardial infarction and without heart failure were evaluated with a lung ultrasound. The presence of B-lines was recorded and counted. The presence of new heart failure (Killip Class B, C, or D) during hospitalization was evaluated by a cardiologist blinded to the results of lung ultrasound. A ROC curve analysis was done to evaluate the diagnostic accuracy of B-lines to predict heart failure.
RESULTS
200 patients were included. Three patients were diagnosed with cardiogenic shock, 5 with acute pulmonary edema, and 17 with mild heart failure. Patients who develop heart failure had a median of 14 B-lines, however, patients who remained in Killip class A had a median of 2 (p = 0,0001). The area under the ROC curve of the sum of B-lines to predict any form of heart failure was 0,91 (CI95% 86-97). The best cut-off value was 5 B-lines, with a sensitivity of 88% (IC95% 68,8-97,5) and specificity of 81% (IC95% 73,9-86,2).
CONCLUSION
Lung ultrasound done at admission can help to predict heart failure In patients with acute myocardial infarction.
Topics: Female; Follow-Up Studies; Humans; Lung; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Prognosis; Pulmonary Edema; Retrospective Studies; Ultrasonography
PubMed: 33714393
DOI: 10.1016/j.ihj.2020.11.148 -
Journal of Investigative Medicine High... 2020Pulmonary complications from cocaine use can range from bronchospasm to vasospasm leading to pulmonary infarction. Profound vasospasm may also lead to perfusion defects...
Pulmonary complications from cocaine use can range from bronchospasm to vasospasm leading to pulmonary infarction. Profound vasospasm may also lead to perfusion defects presenting as pulmonary embolism on ventilation-perfusion scan. A 65-year-old patient with a past medical history of substance abuse and chronic kidney disease presents to the emergency department with sudden-onset chest pain and shortness of breath. Ventilation-perfusion scan revealed filling defect most notably in the lingual lobe. He was later discharged on warfarin for the management of pulmonary embolism. The patient presented to the emergency department 2 weeks later with similar complaints; the international normalized ratio was subtherapeutic, and urine drug screen was positive for cocaine. Repeat ventilation-perfusion scan revealed no filling defects. Follow-up bilateral venous Doppler of lower extremities and D-dimer were within normal limits.
Topics: Aged; Cocaine; Humans; Lung; Male; Pulmonary Embolism; Tomography, Emission-Computed, Single-Photon; Ventilation-Perfusion Ratio
PubMed: 32054344
DOI: 10.1177/2324709620906962 -
American Journal of Respiratory and... Feb 2021Implementation of the Hospital Readmissions Reduction Program (HRRP) following discharge of patients with chronic obstructive pulmonary disease (COPD) has led to a...
Implementation of the Hospital Readmissions Reduction Program (HRRP) following discharge of patients with chronic obstructive pulmonary disease (COPD) has led to a reduction in 30-day readmissions with unknown effects on postdischarge mortality. To examine the association of HRRP with 30-day hospital readmission and 30-day postdischarge mortality rate in patients after discharge from COPD hospitalization. Retrospective cohort study of readmission and mortality rates in a national cohort ( = 4,587,542) of admissions of Medicare fee-for-service beneficiaries 65 years or older with COPD from 2006 to 2017. Data were analyzed for three nonoverlapping periods based on implementation of the HRRP specific to COPD: ) preannouncement (December 2006 to March 2010), ) announcement (April 2010 to August 2014), and ) implementation (October 2014 to November 2017). The 30-day readmission rate decreased from 20.54% in the preannouncement period (December 2006 to July 2008) to 18.74% in the implementation period (May 2016 to November 2017). The 30-day risk-standardized postdischarge mortality rates were 6.91%, 6.59%, and 7.30% for the preannouncement, announcement, and implementation periods, respectively. Generalized estimating equations analyses estimated an additional 1,196 deaths (October 2014 to April 2016) and 3,858 deaths (May 2016 to November 2017) during the HRRP implementation period. We found a reduction in 30-day all-cause readmission rate during the implementation period compared with the preannouncement phase. HRRP implementation was also associated with a significant increase in 30-day mortality after discharge from COPD hospitalization. Additional research is necessary to confirm our findings and understand the factors contributing to increased mortality in patients with COPD in the HRRP implementation period.
Topics: Aged; Aged, 80 and over; Cohort Studies; Female; Heart Failure; Hospitalization; Humans; Male; Myocardial Infarction; Patient Readmission; Pneumonia; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; United States
PubMed: 32871097
DOI: 10.1164/rccm.202002-0310OC -
European Heart Journal Supplements :... Nov 2020Albeit largely underappreciated, chronic obstructive pulmonary disease (COPD) constitutes a major risk factor for cardiovascular diseases in general and for coronary...
Albeit largely underappreciated, chronic obstructive pulmonary disease (COPD) constitutes a major risk factor for cardiovascular diseases in general and for coronary disease in particular. The incidence of myocardial infarction, in fact increases rapidly, after relapse of COPD, with a peak event rate during the first week in the worst forms (those requiring hospitalization). Even though the precise mechanism is not completely defined, it is likely derived from two pathogenetic causes: (i) mismatch between myocardial demand and offer of O (not fully demonstrated and limited to few cases); (ii) acute coronary thrombosis, probably due to a systemic inflammatory reaction, brought upon by multiple interaction between the infective agent and the host immune system.
PubMed: 33239991
DOI: 10.1093/eurheartj/suaa156 -
BMC Cardiovascular Disorders May 2021Venous thromboembolism clinically presenting with a deep vein thrombosis or pulmonary embolism is among the most commonly seen cardiovascular syndromes. The aim of this...
BACKGROUND
Venous thromboembolism clinically presenting with a deep vein thrombosis or pulmonary embolism is among the most commonly seen cardiovascular syndromes. The aim of this case presentation is to emphasise the typical electrocardiographic findings that are detected with massive pulmonary embolism along with the electrocardiographic S1Q3 and S1Q3T3 accompanied by T negativity at the D3 derivation based on prevalent T negativity.
CASE PRESENTATION
We present the case of an adult male who presented with a massive pulmonary embolism that was associated with tachycardia, haemoptysis and typical S1Q3T3 electrocardiographic findings. Tomographic findings showed filling defects in the two main pulmonary artery lumens, which were found to be compatible with a massive embolism. Intravenous heparin was injected (5000 IU), and low molecule weight heparin (LMWH) treatment was initiated. After two days of observation and treatment in the coronary intensive care unit, the patient was discharged for outpatient care.
DISCUSSION
Massive pulmonary embolism is an urgent life-threatening clinical situation that is frequently confused with acute ST elevation myocardial infarction. The definitive diagnosis of massive pulmonary embolism was made with a computed tomography pulmonary angiogram. Electrocardiographic findings and hypoxic hypercarbia in the blood gas analysis are typical. Early diagnosis with laboratory and imaging investigations is vital in the treatment and prognosis of pulmonary embolism.
CONCLUSIONS
Ventricular overload signs accompanied by ST segment elevation in electrocardiography and S1Q3 and prevalent T negativity are crucial features in terms of distinguishing between pulmonary embolism and myocardial infarction and selecting effective treatments for patients admitted to the emergency department.
Topics: Anticoagulants; Clinical Decision-Making; Computed Tomography Angiography; Diagnosis, Differential; Electrocardiography; Hemoptysis; Heparin; Humans; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Pulmonary Embolism; Treatment Outcome
PubMed: 33932981
DOI: 10.1186/s12872-021-02035-0 -
Respiratory Medicine Case Reports 2019Osteoporotic vertebral fractures are common among the geriatric population and are managed by vertebral augmentation procedures. Pulmonary cement embolism is a...
Osteoporotic vertebral fractures are common among the geriatric population and are managed by vertebral augmentation procedures. Pulmonary cement embolism is a relatively rare complication of these procedures and can range from mild, transient respiratory sequelae to a more severe pulmonary infarction. We discuss the case of a 75-year-old woman, identified with osteoporotic thoracolumbar vertebral fractures, found to have pulmonary cement embolism four days following multi-level balloon kyphoplasty. We attempt to highlight, pulmonary cement embolism as a potential complication following a vertebral augmentation procedure and that systematic pulmonary imaging after surgery may be helpful to facilitate its detection and further management.
PubMed: 31304083
DOI: 10.1016/j.rmcr.2019.100887 -
Turkish Journal of Emergency Medicine 2021Coronavirus disease 2019 (COVID-19) disease leads to a hypercoagulable state and associated with thrombotic events that can cause mortality and morbidity. Thrombotic...
Coronavirus disease 2019 (COVID-19) disease leads to a hypercoagulable state and associated with thrombotic events that can cause mortality and morbidity. Thrombotic events include both venous and arterial thrombosis. In this case report, we present a 68-year-old COVID-19 patient with multisystemic infarction who was admitted to the hospital by splenic infarction and later pulmonary embolism diagnosed during the stay in hospital despite anticoagulant use. It is important for emergency physicians to know that patients who had COVID-19 infection but not confirmed or not tested can visit the emergency department due to complications of COVID-19 infection such as thromboembolic events primarily.
PubMed: 34849435
DOI: 10.4103/2452-2473.329627