جستجوی مقالات مرتبط با کلیدواژه "acute pulmonary embolism" در نشریات گروه "پزشکی"

Acute pulmonary embolism can quickly cause hemodynamic collapse and death. Recent studies have shown that different characteristics of electrocardiogram (ECG) can be used to predict the prognosis of patients. This study aimed to investigate the relative frequency of fragmented QRS in the ECG of patients with pulmonary embolism and its prognostic value.

This study was conducted retrospectively. The files of 106 patients hospitalized with a diagnosis of pulmonary embolism from January 2016 to the end of March 2020 were selected and reviewed. The findings of the ECG, including the ST elevation in V1-V4 leads with and without T invention, right axis deviation, right bundle branch block (RBBB), PR, QRS, QTc intervals, type of treatment (thrombolysis or embolectomy), cardiogenic shock, mortality were collected. Finally, the data were recorded and analyzed in SPSS software Version 16.

Hypertension, dyslipidemia, and diabetes mellitus were the most frequent risk factors among the patients. The relative frequency of fragmented QRS, at least in one lead, was 26.2%. The use of thrombolysis, mechanical ventilation, embolectomy, cardiogenic shock, and in-hospital death was significantly higher among patients who had fragmented QRS (P<0.001). CTNI was significantly higher in patients with fragmented QRS (P=0.001). In patients with fragmented QRS large vessels, involvement was significantly higher.

This study showed that the presence of fragmented QRS in the ECG of acute embolism patients has a significant relationship with cardiogenic shock, hospital mortality, and the need for advanced treatment methods such as intubation, embolectomy, and the use of thrombolysis.

Acute pulmonary thromboembolism with a mortality of about 15-20% is the third leading cause of death from vascular disease after myocardial infarction and cerebrovascular disease. Considering the ominous nature of the disease and our experience of observing significant degrees of pulmonary hypertension among these patients, we decided to evaluate the prevalence of echocardiographic findings and its relationship with in-hospital mortality of affected patients.

In this cross-sectional study, we enrolled 183 patients with a definitive diagnosis of pulmonary embolism having admission echocardiography. Clinical and echocardiographic findings were extracted from patients' medical records. Patients were grouped as survivors to hospital discharge and non-survivors, and the relationship between echocardiographic findings and in-hospital mortality was evaluated. All data analysis was performed using SPSS software version 22 and the significance level was considered less than 0.05.

In-hospital mortality rate of our patients was 20.2%. Dyspnea and chest pain were the most prevalent symptoms, while tachycardia, tachypnea and hypotension were the most frequent signs. Average systolic pulmonary artery pressure was about 50.82±22.88 mmHg with significant difference between deceased and discharged subjects. We also reported a significant relationship between in-hospital mortality and TR severity and right ventricular dysfunction. Severe pulmonary hypertension was present in 42% of the patients, and about one third of them didn't survive to the hospital discharge. However, only 14 patients with less than severe PH on presentation expired during hospital stay (p=0.002).

High frequency of severe pulmonary hypertension observed in our acute presenting patients could be a sign of combined PH etiologies and warrant further evaluation of secondary causes.

The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV) dysfunction and myocardial injury.

In this retrospective study, the medical records of 187 patients with a diagnosis of intermediatehigh risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both inhospital and 30 days follow-up data of patients from medical records.

During the in-hospital stay (9.5±4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P=0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002- 1.016; P=0.044) were found to be independent predictors for in-hospital mortality in a multivariate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P=0.002) and dementia (OR, 0.029, 95%CI, 0.002-0.516; P=0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P=0.049) were associated with 30 days mortality.

HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality

Acute pulmonary embolism (APE) may lead to life-threatening conditions such as cardiac death and congestive heart failure. Thus, a proper diagnosis and management play a crucial role to prevent such complications. Moreover, APE is a rare clinical onset of chronic myeloproliferative disease. We herein describe a 67-year-old patient with polycythemia vera presented to our cardiology clinic with pulmonary embolism despite the fact that an intense antiplatelet treatment started secondary to acute myocardial infarction prior. Because the patient had hypotension and head trauma, rheolytic thrombectomy was performed successfully to restore adequate pulmonary perfusion.

Safe exclusion and risk stratification are currently recommended for the initial management of patients with acute pulmonary embolism (APE). The aim of this study was to assess the safe exclusion and risk stratification value of D-dimer (DD) for APE when testedat the beginning of admission. All consecutive Chinese APE patients and controls were recruited from January 2010 to December 2012. All measurements of serum indexes were made in duplicate and blinded to the patients’ status. All the 40 patients with the first episode of APE were confirmed by multi-detector computed tomographic pulmonary angiography. The plasma prothrombintime (PT), activated partial thromboplastin time, thrombin time, fibrinogen, and DD levels were measured within 24 h of admission. We used the Mann-Whitney U-test to determine the differences between groups and drew receiver operator characteristic curve to evaluate the indexes’ value in the APE screening. The PT and DD in the APE group were significantly higher than those in the disease control group (P < 0.05). Taking PT and DD as the useful screening tests for APE and AUC was 0.765 and 0.822, respectively. DD yielded the higher screening efficiency, with DD >1820 μg/L as cut-off value, the sensitivity, specificity, positive and negative predictive value was 82.5%, 75.2%, 56.9%, and 91.6%, respectively. The patients with APE showed significant higher DD levels compared with disease controls, suggesting a negative qualitative DD test result can safely and efficiently exclude APE in primary care.