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Thursday, 28 November 2013

Pulmonary vascular disease – Pulmonary embolism – The Complications and Diseases associated

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 affects as many as 500,000 persons annually in the United States.
C. Complications and diseases associated to pulmonary embolism
C.1. Complications
1. Endomyocarditis
Pulmonary embolism (PE) is a significant cause of morbidity and mortality. In a recent study in patients with PE, an increased level of macrophages was found in the right ventricle. In teh study to evaluate the presence of inflammatory cells, myocytolysis and intracavitary thrombi in the left and right ventricle of patients who died because of PE as a putative new source of heart failure, showed that in patients with PE, endomyocarditis and intracavitary thrombi in the left and right ventricle were found. These abnormalities may be an additional new explanation for the observed cardiac enzyme release and functional abnormalities of the heart in these patients and may contribute to the morbidity and mortality of the disease(19).
2. Other complications
In a study by the the University Medical Center Mannheim, of 65 patients with confirmed acute PE, hs-cTnI and D-dimer values were measured. Adverse clinical outcome was defined as cardiogenic shock, cardiopulmonary resuscitation, mechanical ventilation, vasopressor therapy, thrombolysis, catheter intervention or mortality within 60 days of PE. Patients with acute PE and serum hs-cTnI values >0.1 ng/ml showed significantly higher D-dimer concentrations (P= 0.0467) and a 5-fold increased risk of an adverse clinical outcome [odds ratio (OR), 4.9; 95% confidence interval (CI), 1.28-18.66; P=0.0235] compared with patients with acute PE and hs-cTnI values <0.1 ng/ml(20).
C.2. Diseases associated to Pulmonary embolism (PE)
1. Low blood pressure
Massive pulmonary embolism (PE) is characterized by systemic hypotension (defined as a systolic arterial pressure < 90 mm Hg or a drop in systolic arterial pressure of at least 40 mm Hg for at least 15 min which is not caused by new onset arrhythmias) or shock (manifested by evidence of tissue hypoperfusion and hypoxia, including an altered level of consciousness, oliguria, or cool, clammy extremities). Massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy, according to teh study by the New York Medical College(21).
2. Deep Vein Thrombosis (DVT)
The average annual incidence of deep vein thrombosis alone was 48 per 100,000, while the incidence of pulmonary embolism with or without deep vein thrombosis was 23 per 100,000. The incidence rates of deep vein thrombosis and pulmonary embolism increased exponentially with age, according to the University of Massachusetts Medical School(22).
3. Congenital heart disease
Long-term complications of congenital heart diseases include rhythm disturbances, pulmonary hypertension, or heart failure are frequent, despite optimal care. Acute complications like arrhythmias, infective endocarditis, cerebral events, cerebral abscesses, aortic dissection, pulmonary embolism, and bleeding(23)
4. Pleural Effusion
Pulmonary embolism (PE) is the fourth cause of pleural effusions, after pneumonia, neoinfiltrates and tuberculosis, according to the study by the Institute of Lung Diseases and Tuberculosis(24).
5. Pulmonary edema
There is a report of a case of severe pulmonary embolism in a 37 years old man admitted to the intensive care unit for severe acute respiratory failure. The presenting signs and symptoms were typical for severe pulmonary oedema(25).
6. Thromboembolic pulmonary hypertension (CTEPH)
Incomplete resolution of acute pulmonary embolism (PE) is frequently observed after acute PE and may rarely result in chronic thromboembolic pulmonary hypertension (CTEPH)(26).
7. Pulmonary hypertension
Incomplete resolution of acute pulmonary embolism (PE) is frequently observed after acute PE and may rarely result in chronic thromboembolic pulmonary hypertension (CTEPH). According to the study by the Leiden University Medical Center, CTEPH is associated with a poor prognosis if left untreated. Therefore, the diagnostic approach of CTEPH aims at assessing the location and extent of the embolic obstruction, establishing the operability and prognosis of the patients and ruling out other variations of pulmonary hypertension with distinct indicated treatment(27).
8. Chronic obstructive pulmonary disease and chronic renal failure
There is a report of a 75-year-old man affected by a chronic obstructive pulmonary disease and chronic renal failure admitted to our emergency department for dyspnea and interscapular stabbing pain. Chest radiography showed diffuse parenchymal consolidation in the lower right lung with bronchiectasis, but the treatment for infection disease did not improve the clinical conditions of the patient. According to Wells score indicating an intermediate risk for pulmonary embolism, chest ultrasonography that showed ultrasonographic patterns of thromboembolism(28).
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Sources
(19) http://www.ncbi.nlm.nih.gov/pubmed/17646195
(20) http://www.ncbi.nlm.nih.gov/pubmed/23403884
(21) http://www.ncbi.nlm.nih.gov/pubmed/23319967
(22) http://www.ncbi.nlm.nih.gov/pubmed/2025141
(23) http://www.ncbi.nlm.nih.gov/pubmed/23318541
(24) http://www.ncbi.nlm.nih.gov/pubmed/23425873
(25) http://www.ncbi.nlm.nih.gov/pubmed/6704566
(26) http://www.ncbi.nlm.nih.gov/pubmed/23607029
(27) http://www.ncbi.nlm.nih.gov/pubmed/22648493
(28) http://www.ncbi.nlm.nih.gov/pubmed/22154162