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Korean Journal of Anesthesiology Dec 2011A pulmonary embolism and cerebral infarction are the second and third most common acute cardiovascular diseases after a myocardial infarction. Early diagnosis and...
A pulmonary embolism and cerebral infarction are the second and third most common acute cardiovascular diseases after a myocardial infarction. Early diagnosis and appropriate management are important clinical challenges. In this case, a fatal pulmonary embolism and extensive cerebral infarction caused cardiac arrest during spinal anesthesia for total hip replacement surgery. Transesophageal echocardiography indicated a pulmonary embolism and brain CT showed large area of acute infarction at right middle cerebral artery territory. Pulmonary CT angiogram revealed massive pulmonary embolism findings. This paper reviews this case and suggests other preventive modalities.
PubMed: 22220231
DOI: 10.4097/kjae.2011.61.6.515 -
Medicina Intensiva Mar 2006Both acute myocardial infarction and pulmonary thromboembolism are responsible for a great number of cardiac arrests. Both present high rates of mortality. Thrombolysis... (Review)
Review
Both acute myocardial infarction and pulmonary thromboembolism are responsible for a great number of cardiac arrests. Both present high rates of mortality. Thrombolysis has proved to be an effective treatment for acute myocardial infarction and pulmonary thromboembolism with shock. It would be worth considering whether thrombolysis could be effective and safe during or after cardiopulmonary resuscitation (CPR). Unfortunately, too few clinical studies presenting sufficient scientific data exist in order to respond adequately to this question. However, most studies they show that thrombolysis applied during and after CPR is a therapeutic option that is not associated with greater risk of serious hemorrhaging and could possibly have beneficial effects. On the other hand, experimental data exists which show that thrombolytics can attenuate neurological damage produced after CPR. Nevertheless, clinical trials would be necessary in order to adequately establish the effectiveness and safety of thrombolysis in patients who require CPR.
Topics: Cardiopulmonary Resuscitation; Heart Arrest; Humans; Myocardial Infarction; Pulmonary Embolism; Thrombolytic Therapy
PubMed: 16706330
DOI: 10.1016/s0210-5691(06)74470-9 -
Tuberkuloz Ve Toraks Sep 2020Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous...
Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous thrombosis, gastrointestinal system lesions and skin lesions can be seen. Large, medium or small arteries and veins may be involved. While venous lesions cause occlusion, arterial lesions can cause both occlusion and aneurysm. Major forms of pulmonary involvement include pulmonary artery aneurysm, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, and pleurisy. In Behcet's disease, pulmonary thromboembolism (PE) is often associated with endothelial damage. Neutrophils play an important role in the pathogenesis of thrombosis. Coagulation components such as fibrinogen, thrombin, factor Xa and factor VIIa activate the inflammatory cascade and induce vascular events. It is important to understand the pathogenesis of vascular events in determining the effective treatment strategy. Here we present a patient with Behcet's disease who was presented with pulmonary embolism and was investigated for the etiology of thrombosis.
Topics: Behcet Syndrome; Humans; Male; Middle Aged; Pulmonary Artery; Pulmonary Embolism; Tomography, X-Ray Computed; Ultrasonography, Doppler; Venous Thrombosis
PubMed: 33295733
DOI: 10.5578/tt.69502 -
Cureus Aug 2023Acute ST-elevation myocardial infarction (STEMI), acute ischemic stroke (AIS), and acute pulmonary embolism (PE) are life-threatening conditions, each posing a high risk...
Acute ST-elevation myocardial infarction (STEMI), acute ischemic stroke (AIS), and acute pulmonary embolism (PE) are life-threatening conditions, each posing a high risk of morbidity and mortality. When all three of these acute conditions occur simultaneously, the overall prognosis for the patient becomes considerably worse. We report a case of a 70-year-old woman who presented to the emergency department (ED) with a triad of acute STEMI, AIS, and PE as a consequence of atherosclerotic heart disease, atrial fibrillation, and a prolonged transatlantic flight. The diagnoses were promptly confirmed through emergent coronary and cerebral angiography, along with a computerized tomography pulmonary angiogram (CTPA). The patient underwent a combination of medical therapy and endovascular thrombectomy. However, she later developed a subarachnoid hemorrhage and eventually progressed to brain death.
PubMed: 37767245
DOI: 10.7759/cureus.44222 -
Journal of the American Heart... Dec 2022Background Descriptions of do not attempt resuscitation (DNAR) orders in heart failure (HF) are limited. We describe use of DNAR orders in HF hospitalizations relative...
Background Descriptions of do not attempt resuscitation (DNAR) orders in heart failure (HF) are limited. We describe use of DNAR orders in HF hospitalizations relative to other common conditions, focusing on race. Methods and Results This was a retrospective study of all adult hospitalizations for HF, acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), and pneumonia from 2010 to 2016 using the California State Inpatient Dataset. Using a hierarchical multivariable logistic regression model with random effects for the hospital, we identified factors associated with DNAR orders for each condition. For racial variation, hospitals were divided into quintiles based on proportion of Black patients cared for. Our cohort comprised 399 816 HF, 190 802 AMI, 192 640 COPD, and 269 262 pneumonia hospitalizations. DNAR orders were most prevalent in HF (11.9%), followed by pneumonia (11.1%), COPD (7.9%), and AMI (7.1%). Prevalence of DNAR orders did not change from 2010 to 2016 for each condition. For all conditions, DNAR orders were more common in elderly people, women, and White people with significant site-level variation across 472 hospitals. For HF and COPD, hospitalizations at sites that cared for a higher proportion of Black patients were less likely associated with DNAR orders. For AMI and pneumonia, conditions such as dementia and malignancy were strongly associated with DNAR orders. Conclusions DNAR orders were present in 12% of HF hospitalizations, similar to pneumonia but higher than AMI and COPD. For HF, we noted significant variability across sites when stratified by proportion of Black patients cared for, suggesting geographic and racial differences in end-of-life care.
Topics: Humans; Female; Aged; Retrospective Studies; Heart Failure; Myocardial Infarction; Pneumonia; Pulmonary Disease, Chronic Obstructive
PubMed: 36382963
DOI: 10.1161/JAHA.122.025730 -
European Journal of Case Reports in... 2022The main ultrasound criterion for diagnosing pulmonary infarction is the presence of triangular/wedge-shaped or rounded, hypoechogenic, homogeneous, pleura-based...
UNLABELLED
The main ultrasound criterion for diagnosing pulmonary infarction is the presence of triangular/wedge-shaped or rounded, hypoechogenic, homogeneous, pleura-based lesions. When used in point-of-care, ultrasonography of several organs can facilitate the diagnosis of pulmonary embolism in a patient presenting with chest pain. We describe a case of chest pain which we thought was due to angina, but point-of-care ultrasonography directed us to a diagnosis of pulmonary embolism.
LEARNING POINTS
Point-of-care ultrasonography can help the clinician make a rapid diagnosis in patients with acute respiratory failure.The main ultrasound criterion for diagnosing pulmonary infarction is the presence of triangular/wedge-shaped or rounded, hypoechogenic, pleura-based lesions.
PubMed: 35402328
DOI: 10.12890/2022_003272 -
Clinical Imaging Dec 2021
Topics: COVID-19; Humans; Lung; Pulmonary Embolism; Pulmonary Infarction; SARS-CoV-2
PubMed: 34332464
DOI: 10.1016/j.clinimag.2021.07.014 -
Turkish Thoracic Journal Jan 2021The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE.
OBJECTIVE
The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE.
MATERIAL AND METHODS
Two hundred and twenty patients with acute PE were consecutively enrolled and followed for 30 days after discharge. Serum CRP and NT-proBNP were determined. Right ventricular function was evaluated by transthoracic echocardiography.
RESULTS
There was a significant difference in age, S-PESI, and CRP levels between the early mortality group and without early mortality group. There was statistically no significant difference between the groups with and without early mortality in terms of gender distribution and whether or not they received thrombolytic therapy for DVT. Pulmonary infarct, pleural fluid, or both have no effect on early mortality. There was no correlation between CRP and pro-BNP, right/left ventricular ratio. The serum CRP levels at diagnosis were significantly higher in patients with PE and with pleural effusion and pulmonary infarct than those in PE patients without pleural effusion and pulmonary infarct (4.75±4.91 ng/mL, 9.67±8.02 ng/mL; p<0.0003).
CONCLUSION
High levels of CRP owing to inflammation in pulmonary embolism associated with effusion and infarction reveals why early mortality is significant in this group. CRP may help in the risk stratification of patients with acute PE, especially those with effusion and pulmonary infarction. CRP is an inexpensive and easily applicable biochemical marker, which can be used to predict early mortality.
PubMed: 33646097
DOI: 10.5152/TurkThoracJ.2020.19048 -
Cureus Oct 2021With the emergence of diverse post-COVID sequelae, there have been reports of thromboembolic events such as stroke, myocardial infarction, and pulmonary embolism. These...
With the emergence of diverse post-COVID sequelae, there have been reports of thromboembolic events such as stroke, myocardial infarction, and pulmonary embolism. These events have been reported after severe coronavirus disease 2019 (COVID-19) infections mostly requiring intensive care unit admissions. The findings of acute pulmonary embolism on electrocardiography are commonly sinus tachycardia and S1Q3T3. However, the presentation of pulmonary embolism with arrhythmias is rare. We report a case of a young 31-year-old female who had a history of COVID-19 with a chest computed tomography (CT) severity score of 5/25 five weeks back and presented with acute onset chest pain, breathlessness for one hour followed by collapse. She was intubated in the emergency department and managed with antiarrhythmic drugs however she went into sudden cardiorespiratory arrest and was revived with cardiopulmonary resuscitation. The patient was finally diagnosed as a case of pulmonary embolism leading to pulmonary infarction presenting as paroxysmal supraventricular tachycardia and cardiac arrest as a result of long COVID syndrome. This emphasizes the importance of routine follow-up and strict vigilance even in young patients with mild COVID-19 as it might result in serious life-threatening complications which otherwise seem to be unexpected.
PubMed: 34765348
DOI: 10.7759/cureus.18572 -
Anesthesiology May 2002There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary...
BACKGROUND
There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary practice. The purpose of this study was to determine the frequency of clinically relevant myocardial infarction, pulmonary embolism, deep venous thrombosis, and death within 30 days after elective primary hip or knee arthroplasty treated according to contemporary perioperative management.
METHODS
The authors examined the medical records of consecutive patients undergoing hip or knee arthroplasty at their institution in a 10-yr period. Prospectively collected databases were used to identify patients with the diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis, or death using strict validation criteria and diagnostic-certainty categories.
RESULTS
A total of 10,244 patients underwent primary total hip or knee arthroplasty in the period of study. Of these, 224 patients had one or more adverse events (overall event rate: 2.2%; myocardial infarction: 0.4%; pulmonary embolism: 0.7%; deep venous thrombosis: 1.5%; death: 0.5%). Most adverse events (myocardial infarction, pulmonary embolism, and death) increased in frequency with older age, particularly for patients aged 70 yr or older. Myocardial infarction occurred more frequently in male patients. There were no differences in the overall event frequency between types of procedure. However, pulmonary embolism was highest in patients undergoing bilateral knee operations.
CONCLUSIONS
The overall frequency of serious complications within 30 days after primary total hip or knee arthroplasty with contemporary practice was 2.2%. Accurate knowledge of the perioperative risks associated with widely performed elective operations can be used to implement management strategies that may further improve patient outcomes and decrease cost.
Topics: Adult; Age Factors; Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Databases, Factual; Female; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Pulmonary Embolism; Registries; Sex Factors; Venous Thrombosis
PubMed: 11981154
DOI: 10.1097/00000542-200205000-00017