title: Pulmonary embolism: an observational study at Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore, India.
abstract: Pulmonary embolism (PE) is extremely common and is a leading cause of death in all age groups. Unfortunately the diagnosis is most often missed than it is made. Prompt diagnosis and treatment can dramatically reduce the mortality and morbidity. This study was done to evaluate the patients with acute PE, assess the utility of laboratory tests and potential of high resolution spiral computed tomogram angiography of pulmonary arteries (sCTPA) as the confirmatory diagnostic tool. Twenty six consecutive patients with acute PE admitted to CCU of Narayana Hrudayalaya of Banglore were followed prospectively. There were 15 male and 11 female (M:F=1:3:1); age range was 32-58 yrs. (mean 45+/-13 yrs). Pre-testing probability assessment of PE was done by a combined approach of history, physical examination and presence of risk factors. D-dimer and cardiac troponin I (TnI) estimation and sCPTA done by contrast enhanced 64-slice spiral CT scanner in all patients. In addition to the typical findings of PE, sCTPA included and revealed features of cardiac and venous CT imaging. Doppler study of leg veins were done to exclude deep vein thrombosis. Trans-thoracic echocardiography assessed right ventricular dilatation and presence of pulmonary hypertension. Nineteen patients (73.0%) had sub-massive PE, 5 patients (19.2%) had non-massive and 2 patients (7.6%) presented with massive PE. A raised D-dimer (0.5mugm/ml) was found in all the cases (100.0%). An elevated a trponin I (TnI) was found in 18 patients (69.2%). RV dilatation, (i.e. RV/LV>0.9) was found in 21 patients (80.7%). All patients (100.0%) received unfractionated heparin. Thrombolysis with alteplase, without concomittent heparin was administered in 11 patients (42.3%). Inferior venacaval filter were implanted in 9 patients (34.6%) with sub massive PE and recurrent events despite anticoagulation. Embolectomy done in one patients with massive PE, offered satisfactory recovery. Pulmonary endarterectomy were undertaken in 6 patients with acute on chronic thromboembolic pulmonary hypertension. Thus sCTPA detected PE, source of PE and provided prognostic information.
authors.affiliation: Department of Cardiology, Chittagong Medical College, Chittagong, Bangladesh.
authors.forename: P K
authors.initials: PK
authors.lastname: Das
authors.forename: F
authors.initials: F
authors.lastname: Rahman
authors.forename: P K
authors.initials: PK
authors.lastname: Shetty
authors.forename: D P
authors.initials: DP
authors.lastname: Shetty
mesh_terms: D000208:Acute Disease; D000328:Adult; D000792:Angiography / Q000295:instrumentation*; D015415:Biomarkers; D015150:Echocardiography, Doppler; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging*; D036542:Tomography, Spiral Computed; D019210:Troponin I / Q000378:metabolism
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D019210:Troponin I; C036309:fibrin fragment D