Acute pulmonary embolism with right ventricular dysfunction and left ventricular collapse. Case report.
Abstract
We present the case of a patient with high risk Pulmonary Embolism (PE) due to right ventricular dysfunction and severe hemodynamic dysfunction. The patient required thrombolytic therapy in the context of an initial suspicion of an acute coronary event. PE is a frequent, preventable clinical entity characterized by sudden occlusion of the pulmonary artery. The clinical spectrum is wide, from asymptomatic patients to death by shock and circulatory collapse. The basis of its treatment is anticoagulation. Therapies such as thrombolysis have been shown to have benefits in the mortality of patients in the scenario of shock and hemodynamic instability if there are no contraindications for its use. This entity represents a challenge since the clinical manifestations may be very similar to those of an acute coronary event and other potentially fatal conditions.Downloads
References
Ouellette DW, Patocka C. Pulmonary embolism. Emergency medicine clinics of North America. 2012;30(2):329-75, viii.
Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). European heart journal. 2008;29(18):2276-315.
Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788-830.
Investigators P. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA : the journal of the American Medical Association. 1990;263(20):2753-9.
Konstantinides S, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)Endorsed by the European Respiratory Society (ERS). European heart journal. 2014.
Morales-Blanhir JE, Salas-Pacheco JL, Rosas-Romero MdJ, Valle-Murillo MÁ. Diagnóstico de tromboembolia pulmonar. Archivos de cardiología de México. 2011;81:126-36.
Agnelli G, Becattini C. Acute pulmonary embolism. The New England journal of medicine. 2010;363(3):266-74.
Abbasi OZ, Doan TT, Duggal S, Nair SU, Quinn SM. Utilization of bedside ultrasound in the diagnosis and management of massive pulmonary embolism: a case report. Radiology case reports. 2016;11(4):447-9.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S-94S.10. Buller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. The New England journal of medicine. 2012;366(14):1287-97.
Martin C, Sobolewski K, Bridgeman P, Boutsikaris D. Systemic Thrombolysis for Pulmonary Embolism: A Review. P & T : a peer-reviewed journal for formulary management. 2016;41(12):770-5.
Piazza G. Submassive pulmonary embolism. JAMA : the journal of the American Medical Association. 2013;309(2):171-80.
Mehta N, Sekhri V, Lehrman SG, Aronow WS. Management of massive and submassive pulmonary embolism. American journal of therapeutics. 2013;20(6):664-75.
Ahrens I, Peter K, Lip GY, Bode C. Development and clinical applications of novel oral anticoagulants. Part II. Drugs under clinical investigation. Discovery medicine. 2012;13(73):445-50.
Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. Journal of thrombosis and haemostasis : JTH. 2010;8(11):2450-7.
Pampin-Huerta FR, Moreira-Gomez D, Rodriguez-Lopez V, Madruga-Garrido Mdel P. Systemic Thrombolysis for High-risk Pulmonary Embolism Versus Percutaneous Transcatheter Treatment. Revista espanola de cardiologia (English ed). 2016;69(8):800-1.
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for vte disease: Chest guideline and expert panel report. Chest. 2016;149(2):315-52.
Tafur AJ, Shamoun FE, Patel SI, Tafur D, Donna F, Murad MH. Catheter-Directed Treatment of Pulmonary Embolism: A Systematic Review and Meta-Analysis of Modern Literature. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2016.
Mogollón M, Medina L, Gordgadze T, Saaibi JF, Orozco-Levi M. Tratamiento urgente de la embolia pulmonar aguda mediante el sistema de aspiración por catéter Penumbra. Acta Colombiana de Cuidado Intensivo. 2016;16(1):59-65.
Orozco M MF, Farre N, Gea J, Salvatella N, Medina L,et al. . Tratamiento endovascular urgente de pacientes con tromboembolismo pulmonar grave: Experiencia de dos hospitales (Colombia y España). Revista Colombiana De Neumología. 2013;24(3):120.
Busse LW, Vourlekis JS. Submassive Pulmonary Embolism. Critical care clinics. 2014;30(3):447-73.
Piran S, Schulman S. Management of venous thromboembolism: an update. Thrombosis journal. 2016;14(Suppl 1):23.
Harjola VP, Mebazaa A, Celutkiene J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. European journal of heart failure. 2016;18(3):226-41.
Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. The New England journal of medicine. 2014;370(15):1402-11.
Meyer G, Vieillard-Baron A, Planquette B. Recent advances in the management of pulmonary embolism: focus on the critically ill patients. Annals of intensive care. 2016;6(1):19.
Liew A, Malley T. Tough decisions in pulmonary embolism: thrombolysis or embolectomy? Oxford medical case reports. 2016;2016(9):235-6.
.png)
