폐색전증 Pulmonary embolism

HFrEF 가 background 로 있지만 fluid overload 없이 worsening SOB on exertion 으로 입원했다. 

D-dimer 는 13. mild AKI 가 있었지만 그래도 CTPA.  결과는 PE. 거기에 LV thrombus 도 CTPA 에서 incidental finding. 

cardiology input 도 같이 들어감. 

 

Risk factors 폐색전증 위험요인 

-More than 48 hours of immobility in the preceding month – 45 percent

-Hospital admission in the past three months – 39 percent

-Surgery in the past three months – 34 percent

-Malignancy in the past three months – 34 percent

-Infection in the past three months – 34 percent

-Current hospitalization – 26 percent

 

-Previous thromboembolism 

-Malignancy 

-surgery 

-Trauma 

-Pregnancy 

-Drugs 

   : oral and transdermal contraceptives 

   : hormone replacement therapy 

   : testosterone 

   :tamoxifen 

   :bevacizumab 

   :glucocorticoids 

   :Antidepressants 

-Immobilisation 

  :prolonged sitting 

  :extended travel 

-Antiphospholipid antibodies 

-Renal diseases 

   :chronic renal disease, nephrotic syndrome , renal tranplantation 

-Liver disease 

  : Chronic liver disease 

-Cardiovascular disease 

  :VTE and atherosclerotic disease, heart failure 

-Cardiovascular risk factors 

  :obesity, smoking, age, air pollution, microalbuminuria

-Haematologic risk factors 

  :heparin-induced therombocytopaenia 

  :hyperviscosity 

  :myeloproliferative neoplasms and PNH

-Gastrointestinal 

   :inflammatory bowel disease 

 

Herat failure  -appears to be a hypercoagulable state that can result in intracardiac thrombi and DVT.  -The major risk factors for intracardiac thrombi are reduced LV function and AF  -risk of DVT may be greatest in patients with RHF (e.g. with peripheral oedema)

 

Diagnosis 진단 

D-dimer 

1) PERC rule : Pulmonary Embolism Rule-out criteria    - for patients younger than 50years with a low estimated rate of PE 

2) Wells Criteria for PE : well -validated tools for PE . However, are for outpaitnet or emergency department use, and are not applicable to hospitalised patients

3) CTPA (computed tomography pulmonary angiography) or V/Q (ventilation perfusion isotope) lung scan 

-CTPA is the preferred option for most patients if available 

-If minimal radiation exposure is desired, consider a V/Q scan 

4)Cardiac troponin - to stratify the risk of death in patients presenting with suspected PE and chest pain