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Thursday, 28 November 2013

Pulmonary vascular disease – Pulmonary embolism – The Symptoms

Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
I. Pulmonary embolism
Pulmonary embolism (PE) is defined as a condition of blockage of blood flow due to a blood clot of either in main artery of the lung or somewhere else in the body. In most cases, it is in the deep veins of the legs or pelvic. The disease is a common and affect as many as 500,000 persons annually in the United States
A. Symptoms
1. Dyspnoea and pleuritic chest pain
According to the study by Karolinska Institutet, Department of Clinical Science and Education, Initial symptoms in pulmonary embolism, dominated by dyspnoea and/or pleuritic chest pain were significantly different from those in community-acquired pneumonia, dominated by fever, chills and/or cough (P<0.001)(1).
2. Cough or hemoptysis
Pulmonary embolism (PE) is a life-threatening condition that may present as dyspnea, chest pain, cough or hemoptysis, but often occurs without symptom, according to the study by the New York Medical College(2).
3. Hiccups
There is a report of 3 cases of pulmonary embolism presenting as persistent hiccups.
Including a 52-year-old African-American male without significant prior medical or surgical history presented to the emergency department (ED) with a 3-day history of hiccups. Chest radiograph demonstrating a prominent central pulmonary artery (early Fleishner’s Sign, red arrows) and a cut-off of the pulmonary arteries bilaterally. Computed tomography (CT) showing a saddle embolus (black arrow). B. CT showing a large left pulmonary artery embolus (filling defect, red arrow). C. CT showing a left pulmonary artery embolu(3).
4. Other symptoms
Sudden onset dyspnea was the most frequent symptom in both samples (81 and 78%), followed by chest pain (56 and 39%), fainting or syncope (26 and 22%), and hemoptysis (7 and 5%). At least one of the above symptoms was reported by 756 (94%) of 800 patients. Isolated symptoms and signs of deep vein thrombosis occurred in 3% of the cases. Only 7 (1%) of 800 patients had no symptoms before PE was diagnosed, according to the study by the Università degli Studi di Firenze(4).
5. In severe cases, symptoms include persistent hypotension, arterial oxygen desaturation of less than 70%, myocardial ischemia, Acidosis and hypercarbia accompanied death
Experimental massive pulmonary embolism was created in dogs by injecting a standard-sized clot. Certain changes were found to precede death: 1) persistent hypotension, with fall in arterial blood pressure to levels lower than one half base line, 2) arterial oxygen desaturation of less than 70%, and 3) electrocardiographic changes suggestive of myocardial ischemia. Acidosis and hypercarbia accompanied death(5).
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/16816587
(2) http://www.ncbi.nlm.nih.gov/pubmed/23359617
(3) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555588/
(4) http://www.ncbi.nlm.nih.gov/pubmed/22383978
(5) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1617449/pdf/annsurg01475-0052.pdf