Write a Report On Pulmonary Embolism- Symptoms, Diagnosis and Treatments?
The condition of pulmonary embolism is one such process where one or more than one of the pulmonary arteries in a person’s lungs get blocked. Under most circumstances it has been observed that this condition of pulmonary embolism is fundamentally caused by the clots in the bloods which travel generally from the legs and other parts of the body to the lungs(Barker, 2012). The condition of pulmonary embolism occurs when it is combined with a deep vein thrombosis and in most of the cases doctors state that such a condition may lead to a state known as venous thromboembolism (Stansby&Berridge, 2013).
While any person has the chance to develop the deep vein thrombosis as well as the pulmonary embolism, some of the factors that are dangerous in this regard are immobility, surgery and cancer (Piovella&Iosub, 2015). The condition of pulmonary embolism can in most cases be very life threatening. However, if prompt treatment is done it can help to reduce the risks leading to death. An extremely easy method to prevent this condition is to take appropriate measures for preventing the blood clots that might be taking place in the legs and hence protect against pulmonary embolism.
Further there exist some special types of pulmonary embolism which are generally not caused as a result of blood clots. These types of pulmonary embolism are on the contrary caused due to some other body materials. However, such occurrences are comparatively very rare. These conditions might be due to the fat emboli arising from a broken thigh bone or femur or an amniotic fluid embolus that occurs during pregnancy and in some cases it also occurs from the tumor tissue in case of cancer.
Some of the most common sources that lead to pulmonary embolism are pelvic vein embolus or proximal leg deep venous thrombi (Goodacre et al., 2014). Any of the risk factors of proximal leg deep venous thrombosis tend to increase the risk of the dislodging of the venous clot and migration to the lung circulations. Thrombosis usually develops because of a group of clauses that is known as Virchow’s triad(Kahler, Moss Beam & Kline, 2014). The classical risk factors associated with embolic diseases. The people with advanced age, obesity, prolonged immobility, post-infarction periods, heart failure and pregnancy are predisposing for embolismic disease through venous stasis. The event such as local trauma , vasculitis, and previous thrombosis causes critical damage to the endothelium layer of the venous wall. Contraceptive pills Polycythemia and cancers, especially adeno-carcinomas, are associated with thrombosis disorders with an increased risk of pulmonary embolism. The absence or presence of risk factors for embolic disease is sparingly essential information for the diagnosis and evaluation of the likelihood of pulmonary embolism.
“Although early treatment is highly effective, PE is underdiagnosed and, therefore, the disease remains a major health problem.”(Lavorini et al., 2013)
This condition is primarily considered to be under diagnosed since in most of the cases the symptoms are not specified and the results of the treatment are significant (Sanjeevi, 2012). One of the standard cares is the objective tests which generally either establishes or refutes the PE diagnosis have become a standard of care. This plan of care must be based on the clinical manifestation and evaluation of the chances of pulmonary embolism. The accuracy of these tests is very high when the results are in accordance with the overall assessment.
It is difficult to diagnose clinical symptom of pulmonary embolism. It is often asymptomatic which further add on to the level of difficulty. If the symptoms are present then it is found to be sparingly non- specific sometimes. Trachycardia, cough, loss of consciousness, chest pain and haemoptysis are some of the initial symptom of pulmonary embolism. Pain which is of pleurisy type are often because of PE which causes heavy irritation of pleura and are associated with pulmonary infiltration. It is associated with alveolar hemorrhage as per histopathology and with haemoptysis as a symptom.
The chest X-ray scan is one of the major sources of help in ruling out other conditions (e.g. pulmonary edema, pneumonia, pneumothorax) and that have sparingly clear radiological findings and are of less use in the diagnosis of pulmonary embolism. In about 25% of cases of pulmonary embolism, the chests X-ray are found to be normal. In fact, this is of great assistance, as the coexistence of severe dyspnoea, with a ventilation-perfusion lung scan of even intermediate probability, is practically diagnostic for pulmonary embolism. The only diagnosis available is the haematological examination which is quite advance for of diagnosis that helps in the diagnosis of PE is the measurement and quantification of D-dimers with the ELISA (Enzyme linked immune sorbent assay) method. Although this method is extremely sensitive (i.e.>90%) but it is very non-specific. Since there is a presence of elevated levels of D-dimers in various other disease conditions that are clinically similar to pulmonary embolism, such as pneumonia, post-surgery trauma , cancer, myocardial infarction and heart failure, etc. In view of this, the most important contribution of D-dimers quantification is in ruling out pulmonary embolism when their levels are normal (i.e. high negative predictive values). Pulmonary angiography is one of the widely accepted techniques for the detection of pulmonary embolus within the circulation. It is basically performed whenever some noninvasive techniques and clinical data failed to diagnose the disease. It is an appropriate test to detect the patient with unstable hemodynamics.
Therefore, it can be observed that the diagnosis of this condition is based on the valid clinical criteria and selective tests (Bergrem et al., 2013). This is primarily because the clinical presentations could not be distinguished from the other causes that arise from chest pain and breathe shortage.
One of the known treatments of this condition is Anticoagulant therapy and this is one treatment that would definitely prevail. Intensely, there are also other supporting treatments that are available such as analgesia along with this treatment(Kabrhel, 2013). Mostly the people are admitted in the hospitals during the early stages of the disease and they usually remain under the care unless the INR has reached the appropriate therapeutic levels(Tapson, 2012). Nonetheless, the lower level risks can be managed in the homes itself and such a home treatment is common for this condition.
The major cornerstone therapy for pulmonary embolism is to prevent the recurrence of new embolism by regular dosage of anticoagulants or a filter in the inferior vena cava, since it has been seen that the majority of the patients die due to continue deterioration in health because of formation of new emboli again and again. It is necessary to attempt the primary lysis of the embolus when the person is in haemodynamic condition or in shock.
Conclusion
Pulmonary embolism is among the top three biggest cause of death from cardiovascular diseases after cerebro-vascular stroke and myocardial infarction in today’s world. After the diagnosis the mortality rate of pulmonary embolism is reached up to 15% within in 3 months. Since pulmonary embolism symptoms occur only in the 30% patients so it is very important to diagnose this disease at an early stage. The risk factor is associated to the people taking contraceptive pills, having cancer, pregnancy, undergoing hormonal therapy etc. Various methods are available for the diagnosis but it is really difficult to detect PE at an early stage so most of the diagnostics method fails. Treatment like anticoagulant therapy is widely accepted and shown promising results for dissolving and inhibiting the recurrence of new embolus. Therefore it is very important to detect this disease at early stage in order to save the patient from life threatening experience.
References
Barker, J. (2012).Current Approach to the Diagnosis of Acute Nonmassive Pulmonary Embolism.Yearbook Of Pulmonary Disease, 2012, 227-228.doi:10.1016/j.ypdi.2012.01.078
Bergrem, A., Dahm, A., Jacobsen, A., Sandvik, L., &Sandset, P. (2013). OC-16 Differential risk factors for pregnancy-related deep vein thrombosis and pulmonary embolism – Results from a population-based case-control study. Thrombosis Research, 131, S75.doi:10.1016/s0049-3848(13)70042-2
Goodacre, S., Nelson-Piercy, C., Hunt, B., & Chan, W. (2014). When should we use diagnostic imaging to investigate for pulmonary embolism in pregnant and postpartum women?. Emergency Medicine Journal, 32(1), 78-82.doi:10.1136/emermed-2014-203871
Kabrhel, C. (2013). A Multidisciplinary Pulmonary Embolism Response Team. Chest, 144(5), 1738.doi:10.1378/chest.13-1562
Kahler, Z., Moss Beam, D., & Kline, J. (2014). 91 Physician Attitudes Toward Immediate Discharge of Low-Risk Pulmonary Embolism Patients from the Emergency Department. Annals Of Emergency Medicine, 64(4), S33.doi:10.1016/j.annemergmed.2014.07.116
Lavorini, F., Di Bello, V., De Rimini, M., Lucignani, G., Marconi, L., &Palareti, G. et al. (2013). Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach. Multidisciplinary Respiratory Medicine, 8(1), 75.doi:10.1186/2049-6958-8-75
Piovella, F., &Iosub, D. (2015). Acute pulmonary embolism: risk assessment, risk stratification and treatment options. The Clinical Respiratory Journal, n/a-n/a. doi:10.1111/crj.12264
Sanjeevi, C. (2012). Autoimmune diseases and risk of pulmonary embolism. The Lancet, 379(9812), 200-201.doi:10.1016/s0140-6736(11)61510-9
Stansby, G., &Berridge, D. (2013). Venous thromboembolism. British Journal Of Surgery, 100(8), 989-990. doi:10.1002/bjs.9187
Tapson, V. (2012).Advances in the Diagnosis and Treatment of Acute Pulmonary Embolism. F1000 Med Rep, 4.doi:10.3410/m4-9
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