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Annals of Noninvasive Electrocardiology... Mar 2022The aim of this study was to investigate the value of electrocardiograms (ECGs) and serological examinations in the differential diagnosis of acute pulmonary embolism...
BACKGROUND
The aim of this study was to investigate the value of electrocardiograms (ECGs) and serological examinations in the differential diagnosis of acute pulmonary embolism (APE) and acute non-ST elevation myocardial infarction (NSTEMI) in order to reduce the rate of clinical misdiagnosis.
METHODS
The clinical data of 37 patients with APE and 103 patients with NSTEMI admitted to our hospital were retrospectively analyzed. The differences in the clinical manifestations, ECGs, myocardial zymograms, D-dimers, and troponin (cTn) of the two groups were compared.
RESULTS
In the patients with APE, the main symptom-found in 25 cases (67.56%)-was dyspnea, while in the patients with NSTEMI, the main symptom-found in 52 cases (50.49%)-was chest tightness. The incidences of sinus tachycardia and S Q T in the group of patients with APE were higher than in the group of patients with NSTEMI, and the difference was statistically significant (p < .05). There was no statistical significance in the difference of aspartate aminotransferase and lactate dehydrogenase (LDH) in the two groups (p > .05), although there was a statistically significant difference of creatine kinase (CK) and the creatine kinase isoenzyme-MB (CK-MB) in the two groups (p < .05). The levels of D-dimers and cTn were increased in both groups, but the level of D-dimers in the group of patients with APE was higher than that in the group of patients with NSTEMI.
CONCLUSION
With the occurrence of clinical manifestations like dyspnea, chest tightness, chest pain, and palpitation of unknown causes, the possibility of APE and NSTEMI should be considered.
Topics: Acute Disease; Anterior Wall Myocardial Infarction; Arrhythmias, Cardiac; Biomarkers; Creatine Kinase; Creatine Kinase, MB Form; Dyspnea; Electrocardiography; Humans; Non-ST Elevated Myocardial Infarction; Pulmonary Embolism; Retrospective Studies; ST Elevation Myocardial Infarction
PubMed: 34882896
DOI: 10.1111/anec.12920 -
Journal of Medical Case Reports Aug 2018Unilateral pulmonary edema is an uncommon condition and is a rare clinical entity that is often misdiagnosed at the initial stages. In a majority of patients it occurs... (Review)
Review
BACKGROUND
Unilateral pulmonary edema is an uncommon condition and is a rare clinical entity that is often misdiagnosed at the initial stages. In a majority of patients it occurs in the upper lobe of the right lung. There are many causes of unilateral pulmonary edema, but the commonest is the presence of a grade 3 mitral regurgitation. Due to its rare presentation, a high index of suspicion is required, and correct management is necessary to reduce the morbidity and mortality.
CASE PRESENTATION
We present a case of right-sided unilateral pulmonary edema in an 86-year-old Sinhalese Sri Lankan woman who presented with acute onset dyspnea with cardiogenic shock due to acute non-ST elevation myocardial infarction, complicated with grade 3 mitral regurgitation. She had clinical features of heart failure and pulmonary edema, but a chest X-ray showed unilateral infiltrates only on the right side. Distinguishing pneumonia from pulmonary edema according to chest X-ray findings was a challenge initially, and she was therefore initially treated for both conditions. She had remarkable clinical and radiological improvement after 12 hours of intravenously administered furosemide and glyceryl trinitrate therapy. Her brain natriuretic peptide level was elevated and further supported and confirmed the diagnosis retrospectively.
CONCLUSIONS
Unilateral pulmonary edema is a completely reversible condition with good patient outcome if it is suspected early and treated early. Even in the absence of readily available echocardiogram skills, a clinical examination is of paramount importance in making a clinical decision in low-resource settings to reduce mortality.
Topics: Aged, 80 and over; Echocardiography; Female; Heart Failure; Humans; Mitral Valve Insufficiency; Non-ST Elevated Myocardial Infarction; Pulmonary Edema; Retrospective Studies; Shock, Cardiogenic
PubMed: 30103814
DOI: 10.1186/s13256-018-1739-3 -
Journal of Thoracic Disease Nov 2023Pulmonary infarction (PI) is an uncommon complication of pulmonary embolism (PE). The risk factors of PI are still relatively unclear.
BACKGROUND
Pulmonary infarction (PI) is an uncommon complication of pulmonary embolism (PE). The risk factors of PI are still relatively unclear.
METHODS
This was a single-center retrospective review conducted on 500 patients with PE. After applying the inclusion and exclusion criteria, 386 patients diagnosed with PE were enrolled in our study. These patients were then categorized into the PI group (n=64) and the non-PI group (n=322). A comparison was conducted between the two groups regarding the clinical characteristics.
RESULTS
The occurrence of PI secondary to PE was 16.58%. In univariate analysis, recent trauma (21.9% 9.9%, P=0.007), pleuritic chest pain (46.9% 17.4%, P<0.001), hemoptysis (29.7% 2.5%, P<0.001), fever (26.6% 8.1%, P<0.001), lower limb edema/pain (37.5% 14.0%, P<0.001), white blood cell (WBC) counts (37.5% 24.5%, P=0.032), C-reactive protein (CRP) (65.6% 41.3%, P<0.001), and pleural effusion (45.3% 18.6%, P<0.001) were associated with an increased risk of PI. Multivariate analysis demonstrated that age [odds ratio (OR) 0.975, 95% confidence interval (CI): 0.951-0.999, P=0.045], pleuritic chest pain (OR 2.878, 95% CI: 1.424-5.814, P=0.003), hemoptysis (OR 10.592, 95% CI: 3.503-32.030, P<0.001), lower limb edema/pain (OR 2.778, 95% CI: 1.342-5.749, P=0.006) and pleural effusion (OR 3.127, 95% CI: 1.531-6.388, P=0.002) were independent factors of PI due to PE. No significant difference was recorded between the two groups in treatment and mortality.
CONCLUSIONS
Young patients were found to be a higher risk of PI. Pleural effusion was found to be a factor for PI. PI should be considered when pleuritic chest pain, hemoptysis, or lower limb edema/pain are present with peripheral opacity.
PubMed: 38090315
DOI: 10.21037/jtd-23-944 -
Cureus Dec 2023Introduction A pulmonary embolism (PE) occurs when an embolus that has traveled through the venous system from another part of the body obstructs an artery in the...
Introduction A pulmonary embolism (PE) occurs when an embolus that has traveled through the venous system from another part of the body obstructs an artery in the lungs. Chest pain, especially while breathing in, coughing up blood, and shortness of breath are all possible signs of PE. There could also be signs of a blood clot in the leg, like a painful, swollen, red, and warm leg. As a high-risk group, particularly during childbearing age, the aim of this study is to evaluate the general awareness of females regarding PE and identify areas of knowledge deficit and factors contributing to their awareness level. Methods A cross-sectional descriptive survey of Saudi women in general over the age of 18 was carried out. Participants were asked to respond to a structured questionnaire that was used to gather data. The questionnaire was formulated in Google Forms with an Arabic translation of the form and the link generated and was sent to each participant for completion. In total, 827 respondents filled out the survey with accurate and complete information. Results The study comprised 827 female volunteers, with a mean age of 33.2 ± 9.4 years, ranging in age from 15 to 60. Additionally, 52.8% of the female sample had graduated from college, compared to about 4% who were illiterate. In general, 40.2% of the girls knew everything there was to know about PE. Conclusions According to the study's findings, the public female population knew less about PE overall - that is, about risk factors, symptoms, and preventive measures. As more knowledge about the dangers, causes, prevention, diagnosis, and treatment of PE becomes available, it is imperative that healthcare professionals translate and actively distribute this information to the public, particularly to women.
PubMed: 38288230
DOI: 10.7759/cureus.51272 -
Respirology Case Reports Sep 2021A 28-year-old woman with a history of treatment with a low-dose oestrogen-progestin (LEP) formulation presented to our hospital due to right chest pain. She had just...
A 28-year-old woman with a history of treatment with a low-dose oestrogen-progestin (LEP) formulation presented to our hospital due to right chest pain. She had just been discharged from another hospital for pneumonia and pleurisy which had improved with antibiotics. Contrast-enhanced computed tomography (CT) revealed bilateral pulmonary emboli corresponding to the peripheral consolidations. The pulmonary emboli indicated that the peripheral consolidation was due to pulmonary infarction (PI). No aetiological factors were identified except for the history of LEP therapy. Although the typical CT images of PI are consolidations in the peripheral area, these finding are non-specific for PI. This case of PI was misdiagnosed as infection because of response to antibiotics and similar CT findings. Therefore, careful evaluation of the patient history and clinical findings are imperative for accurate diagnosis. Venous thromboembolism can occur frequently around 3 months after the start of LEP treatment.
PubMed: 34430034
DOI: 10.1002/rcr2.833 -
Cardiovascular Diagnosis and Therapy Apr 2021Post-mortem cardiac magnetic resonance (CMR) is a non-invasive alternative to conventional autopsy. At present, diagnostic guidelines for cardiovascular conditions such...
BACKGROUND
Post-mortem cardiac magnetic resonance (CMR) is a non-invasive alternative to conventional autopsy. At present, diagnostic guidelines for cardiovascular conditions such as hypertrophic cardiomyopathy have not been established. We correlated post-mortem CMR images to definite conventional autopsy findings and hypothesed that elevated T2-weighted signal intensity and RV to LV area ratios can identify myocardial infarction and pulmonary emboli respectively.
METHODS
For this unblinded pilot sub-study, we selected cases from the original blinded study that compared post-mortem imaging to conventional autopsy in patients referred for coronial investigation between October 2014 to November 2016. Three groups of scans were selected based on the cause of death identified by conventional autopsy: non-cardiovascular causes of death with no structural cardiac abnormality i.e., control cases, acute/subacute myocardial infarction and pulmonary emboli. Left ventricular (LV) wall thickness, LV myocardial signal intensity and ventricular cavity areas were measured.
RESULTS
Fifty-six scans were selected [39 (69.6%) males]: 37 (66.1%) controls, eight (14.3%) acute/subacute myocardial infarction and eleven (19.6%) pulmonary emboli. The median age was 61 years [Interquartile range (IQR) 50-73] and the median time from death to imaging and autopsy was 2 days (IQR 2-3) and 3 days (IQR 3-4). The septal and lateral walls were thicker {15 mm [13-17] and 15 mm [14-18]} on post-mortem CMR than published ante-mortem measurements. Areas of acute/subacute myocardial infarction had significantly higher T2-weighted signal intensity (normalised to skeletal muscle) compared to normal myocardium in those who died from other causes {2.5 [2.3-3.0.] 1.9 [1.8-2.3]; P<0.001}. In cases with pulmonary emboli, there was definite RV enlargement with a larger indexed RV to LV area ratio compared to those who died from other causes {2.9 [2.5-3.0] 1.8 [1.5-2.0]; P<0.001}.
CONCLUSIONS
We present potential post-mortem CMR parameters to identify important cardiovascular abnormalities that may be beneficial when conventional autopsy cannot be performed. In patients without cardiovascular disease, LV wall thickness was found to be unreliable in diagnosing hypertrophic cardiomyopathy without histological and/or genetic testing. Elevated T2 signal intensity and RV to LV area ratios may be useful markers for acute/subacute myocardial infarction and pulmonary emboli. Larger studies will be necessary to define cut-offs.
PubMed: 33968616
DOI: 10.21037/cdt-20-948 -
Spine Jul 2023A hospital-wide medication management program was implemented to ensure that high-risk patients would systematically pause antiplatelet and anticoagulant medications. We...
STUDY DESIGN
A hospital-wide medication management program was implemented to ensure that high-risk patients would systematically pause antiplatelet and anticoagulant medications. We analyzed complications before and during the implementation of this program.
OBJECTIVE
The goal of the study was to determine if a medication management support program was effective for reducing perioperative complications, including hemorrhage, myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis.
DATA AND METHODS
Using data from the National Surgical Quality Improvement Program database, we examined the presence of 5 complications before and during the implementation of a medication management support program. There were 9732 patients in the clinic population who underwent elective spine surgery between 2011 and 2020 and were included in this analysis. Of those 9732 patients, 7205 had surgery before the introduction of the program, whereas 2527 had surgery at some point after the program was introduced. We conducted a series of Pearson's χ 2 tests to determine the relative frequencies of the complications before and during the program.
RESULTS
Results showed that during the implementation of the program, patients were relatively less likely to experience hemorrhage (3.16% vs. 1.11%; P <0.001). The reductions in thrombotic complications were clinically significant: myocardial infarction (0.12% vs. 0.00%), stroke (0.10% vs. 0.04%), pulmonary embolism (0.33% vs. 0.28%), and deep vein thrombosis (0.36% vs. 0.28%). These P values ranged from P =0.08 for myocardial infarction to P =0.67 for pulmonary embolism.
CONCLUSIONS
The use of this medication management support program appears effective for reducing the need for blood transfusions and thrombotic complications. While promising, the results should be interpreted with caution as we do not know whether this type of program will be effective for other hospital systems.
Topics: Humans; Medication Therapy Management; Retrospective Studies; Pulmonary Embolism; Myocardial Infarction; Thrombosis; Stroke; Venous Thrombosis; Postoperative Complications
PubMed: 36607822
DOI: 10.1097/BRS.0000000000004570 -
Journal of the Belgian Society of... 2023The reversed halo sign, or atoll sign, is a specific sign with ring-shaped consolidation and central lucency, which is historically considered typical for cryptogenic...
The reversed halo sign, or atoll sign, is a specific sign with ring-shaped consolidation and central lucency, which is historically considered typical for cryptogenic organising pneumonia. The presence of this sign in subpleural, posterior basal parts of the lower lobes, especially when solitary, should however raise suspicion for other causes, such as pulmonary infarction. Here, we present a case of pulmonary embolism with pulmonary infarction that was detected on HRCT without contrast. The presence of a reversed halo sign, especially when solitary and located in the periphery of the lower lobes, should raise suspicion of a pulmonary infarction.
PubMed: 37694190
DOI: 10.5334/jbsr.3243 -
Respirology Case Reports Sep 2017Pulmonary arteriovenous malformation (PAVM) is an abnormal blood vessel connecting a pulmonary artery and a vein, and is accompanied by paradoxical embolism to other...
Pulmonary arteriovenous malformation (PAVM) is an abnormal blood vessel connecting a pulmonary artery and a vein, and is accompanied by paradoxical embolism to other organs due to a right-to-left shunt. We report the case of a 66-year-old woman with PAVM complicated by splenic infarction and abscess. Although the PAVM had been detected on a chest image 2 years previously, and she had been advised to have further investigations, she decided not to follow this further at the time. She then visited our hospital complaining of worsening dyspnoea on exertion. Detailed examinations revealed splenic infarction and abscessation due to PAVM. PAVM embolization was performed after antibiotic treatment. It is very rare for PAVM to be complicated by splenic infarction and abscess. Regardless of its size, embolization of a PAVM as soon as possible can reduce not only the risk of central nervous system complications, but also the risk of splenic infarction and abscess.
PubMed: 28736615
DOI: 10.1002/rcr2.254 -
BMJ Open Sep 2015Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD.
DESIGN
Systematic review and meta-analysis.
METHODS
MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible.
RESULTS
Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40).
CONCLUSIONS
There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI.
Topics: Comorbidity; Disease Progression; Humans; Myocardial Infarction; Observational Studies as Topic; Population Surveillance; Pulmonary Disease, Chronic Obstructive; Risk Factors
PubMed: 26362660
DOI: 10.1136/bmjopen-2015-007824