title: Clinical characteristics, management and outcome of major pulmonary embolism: an experience from a tertiary care center in Pakistan.
abstract: OBJECTIVE
  To evaluate the clinical characteristics, risk factors, management and outcome of major pulmonary embolism (PE) in a tertiary care center of Karachi.
  
  
  METHODS
  Medical records of all patients who underwent a spiral CT scan of the chest for suspected pulmonary embolism were reviewed between January 2000 and June 2007 at the Aga Khan University Hospital, Karachi. Patients having evidence of major pulmonary embolism on spiral CT scan were selected.
  
  
  RESULTS
  A total of 30 patients (10 males, 20 females) with mean age 52 +/- 14.59 years were identified who fulfilled our predefined criteria for major pulmonary embolism. Risk factors for thromboembolism were identified in 22 (73%) patients, prolonged immobilization in 8 (27%) and recent surgery in 8 (27%) patients being the commonest. All patients were symptomatic on presentation. Tachypnea and tachycardia were present in 27 (90%) patients. Refractory hypoxia was present in 18 (60%) patients and 3 (10%) were hypotensive on presentation. On spiral CT scan, 8 (27%) patients had embolus in the main pulmonary trunk, 26 (87%) patients in main right pulmonary artery and 20 (67%) patients had left main pulmonary artery embolus. Echocardiography was done in 22 (73%) patients with the findings of right ventricular dysfunction in all of them. All patients except one were treated with anticoagulation with either heparin infusion or low molecular weight heparin. In addition, thrombolytics were given in 7 (23%) patients and five (17%) underwent surgical embolectomy. Four (13%) patients died during hospitalization with a total of 26 (87%) surviving till hospital discharge.
  
  
  CONCLUSIONS
  Major pulmonary embolism is an uncommon but potentially life threatening entity. Early diagnosis and aggressive therapy improves the clinical outcome.
authors.affiliation: Pulmonary & Critical Care, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Shahid Javed
authors.initials: SJ
authors.lastname: Husain
authors.forename: Ali Bin Sarwar
authors.initials: AB
authors.lastname: Zubairi
authors.forename: Kulsoom
authors.initials: K
authors.lastname: Fatima
authors.forename: Muhammad
authors.initials: M
authors.lastname: Irfan
authors.forename: Muhammad
authors.initials: M
authors.lastname: Atif
authors.forename: Muhammad Ammad
authors.initials: MA
authors.lastname: Saeed
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic; D013610:Tachycardia / Q000175:diagnosis; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight