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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Heparin Study in Internal Medicine (HESIM) compares the efficacy and safety of an unfractionated (UF) heparin with a low molecular weight (LMW) heparin (CY 216 D) for prevention of proximal deep vein thrombosis (DVT) and pulmonary embolism (PE) in medical inpatients with a high risk for development of thromboembolism. Patients are randomized and receive three times daily 5000 IU UF heparin or once daily 3100 IU LMW heparin and two placebo injections subcutaneously for 10 days. All patients are screened for the presence of proximal DVT at day 1 and 10 by real-time B-mode compression sonography and for PE by repeated clinical examinations. Perfusion scintigraphy is used for confirmation of the clinical diagnosis of PE. The study protocol includes a stratified randomization of patients on admission to the hospital according to one of the following main diagnoses: malignant disease, cardiovascular disease, bronchopulmonary disease, neurologic disease, and other diseases. The present study may serve as a model for further clinical trials in medical inpatients using the biometric approach of statistical analysis for proving equivalence of drug efficacy, and to adopt less sensitive but noninvasive methods for the detection of primary endpoints.
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PMID:Heparin Study in Internal Medicine (HESIM): design and preliminary results. 133 5

The author analyzes the natural course of acute pulmonary embolism and its progression. Treated acute pulmonary embolism has a favourable long-term prognosis which is negatively influenced only by further diseases. While acute pulmonary embolism is the third most frequent cardiovascular disease--the incidence of chronic thromboembolic pulmonary hypertension is very rare and accounts only for 0.38% in necroptic material.
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PMID:[The relation between acute embolism and thromboembolic pulmonary hypertension]. 237 82

In this review of cardiovascular effects of oral contraceptives (OCs), the risks are identified from 2 prospective cohort studies as 19/10,000 woman years for the risk of thrombosis or thromboembolism. 11 of 19 were superficial thrombosis and 8 were deep vein thrombosis or pulmonary embolism. For women with no risk factors, the risk was 2.0 for superficial thrombosis and 4.0 for deep vein thrombosis. Myocardial infarction (MI) risk is estimated at 7/100,000 current users/year for women 30-39 years and 67/100,000/year for women 40-44 years based on combined British and American studies. 37/100,000/year is the estimated risk for women 30-44 years for either thrombotic or hemorrhagic stroke. 50% of the MIs and 10% of the strokes were fatal. The total annual risk of death from any circulatory disease was estimated at 22-24 deaths/100,000 women years based on 2 British cohort studies. Other predisposing factors also contribute to cardiovascular disease, and separating out the effects has been controversial. In 1985, a study refuted that OCs were responsible for any effect on cardiovascular risk, because of flawed case control studies. One such study is cited which shows that only 16.7% of OC users were confirmed by Doppler ultrasound for deep vein thrombosis compared with 30.7% for nonusers. The general trend in the UK is one of reduced death rates from circulatory disease for women in spite of widespread contraceptive use. This relationship between OC use and cardiovascular disease was evidenced in another study of vital statistics from 21 countries. The pathological mechanisms for the association between OC use and vascular disease are discussed for blood clotting with the importance of predisposing factors highlighted, MI and lipid metabolism and other risk factors, stroke, and breakthrough bleeding. The risk is very low for vascular disease with available low- dose preparations. Risk is further reduced with careful screening of high risk women. The side effects of low-dose pills such as breakthrough bleeding can be treated with cautious use of alternative high-dose formulations and patient education. Low-dose OCs with 30-35 mg of estrogen combined with a low-dose and low androgenic progestin are recommended.
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PMID:Cardiovascular effects of oral contraceptives: a review. 257 58

Considerable evidence from the United Kingdom and North America has shown that oral contraceptive use is associated with an increased risk of cardiovascular disease. However, since little is known about the link between the two in other parts of the world, WHO initiated a hospital-based case-control study in three centres in Mexico, Hong Kong, and the German Democratic Republic. Both cases and controls were asked about their past and current use of contraception as well as details on a number of potential confounding factors. Three main diagnostic categories were studied: venous thromboembolism (VTE) and pulmonary embolism (PE), ischaemic heart disease (IHD), and stroke. An overall relative risk of 2.9 (95% confidence limits, 1.4-6.1) for VTE/PE was found among recent or current users of oral contraceptives. Although this elevated risk is consistent with the results of other studies, the possibility of detection bias cannot be ruled out. The small number of cases (8) of IHD identified in the course of this study greatly limited the conclusions that could be drawn for this disease. Similarly with stroke, the small number of cases limited the conclusions that could be drawn, particularly since it was not possible to distinguish between thrombotic and haemorrhagic stroke. In addition to suggesting an increased risk of VTE/PE, the study pointed out the importance of ensuring an adequate sample size based on newly-diagnosed cases, the need for a coordinating centre to monitor the study closely in each centre and to provide a central review of each case, and the necessity of more specific diagnoses for meaningful interpretation of the data.
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PMID:Cardiovascular disease and use of oral contraceptives. WHO Collaborative Study. 280 19

A case of leiomyosarcoma of the pulmonary artery in a 64-year old man without previous cardiovascular disease is reported. The clinical picture, which comprised episodes of paroxysmal dyspnoea associated with acute cor pulmonale, suggested pulmonary embolism. Radioisotope perfusion study and pulmonary angiography seemed to confirm this diagnosis, but no improvement was obtained with a prolonged thrombolytic treatment. The presence of a median mass at CT led to exploratory thoracotomy and to the finding of a tumour in the pulmonary artery, which turned out to be a leiomyosarcoma. The disease rapidly took an unfavourable course. Comparison of this case with data from the literature showed that primary tumours of the pulmonary artery are extremely rare, that they are diagnosed with difficulty and often at a late stage and that their prognosis is usually very sombre.
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PMID:[Primary leiomyosarcoma of the pulmonary artery. Apropos of a case]. 312 93

Cardiovascular disease is the major cause of death and disability in the elderly. Atherosclerotic coronary heart disease is the most prevalent problem, followed by hypertensive cardiovascular disease. Calcific aortic stenosis is the most common haemodynamically important valvular lesion; surgical correction significantly improves the prognosis. Pulmonary embolism occurs frequently, related to immobilization and co-morbidity. Congestive heart failure is both under-diagnosed and over-diagnosed. Complete heart block and sick sinus syndrome increase with age; appropriate pacemaker therapy can improve the length and quality of life. Clinical evaluation of elderly patients is often hampered by multiple co-existing disease involving other organ systems, problems in reporting symptoms, and associated functional and structural changes of ageing that may mimic or mask cardiovascular disease. Presentations of cardiac illness often differ from those in a younger population. Most of the available data on therapy and prognosis do not apply to contemporary practice, so that clinical decisions are often extrapolated from information acquired in younger patients. Elderly patients are at high risk of complications of most diagnostic and therapeutic procedures, more related to co-morbidity than to age; they have more frequent and serious adverse drug reactions, due both to co-morbidity and to multiple medications. Age as such should not constitute a barrier to cardiac care; in the USA at least one-third of all cardiovascular procedures are performed in elderly patients. The goals of therapy are improvement in function and postponement of debilitating illness, enabling an extended active independent lifestyle.
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PMID:Cardiovascular disease in the elderly. 328 33

This report reviews the present status of cardiovascular surgery in West Africa and highlights some of the constraints of development in this field.Rheumatic heart disease is still endemic in the tropics, where it constitutes about 20 percent of all cases of cardiovascular disease (CVD) in Nigeria. Endomyocardial fibrosis is a disease of unknown etiology accounting for 10 to 20 percent of cases. Purulent pericarditis is a common complication of pyomyositis and osteomyelitis found in 5 percent of patients. Chronic constrictive pericarditis is a sequela of infective pericarditis found in 5 percent of all cases of CVD. Calcification is found in 30 percent of cases and pericardiectomy can be performed successfully without cardiopulmonary bypass. Infective endocarditis is equally rare, occurring in 2.5 percent of cases; it is a common source of septic emboli to coronary artery and a very difficult disease to treat in the West African environment.Ischemic heart disease is relatively uncommon, accounting for less than 0.5 percent of patients. The rarity of the disease in black Africans has been attributed to dietary habits and environment rather than to racial and psychosocial factors. Congenital heart disease accounts for 5 percent of all cases of CVD in this review. Ventricular septal defect and patent ductus arteriosus are the most common acyanotic defects, while tetralogy of Fallot and transposition of the great arteries are the most common cyanotic defects.Vascular diseases are uncommon in this series, with traumatic injuries accounting for most of the cases. Abdominal aortic aneurysms, peripheral occlusive vascular disease, and atherosclerotic aortic aneurysms are quite rare. This review further confirms the rarity of deep venous thrombosis and pulmonary embolism in Africans.
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PMID:The status of cardiovascular surgery in West Africa. 331 74

A case control study was conducted in Mexican Institute of Social Security hospitals in the Valley of Mexico to determine the relationship between oral contraceptive (OC) use and nonrheumatic cardiovascular disease in Mexican women. The study involved Mexican women between 20-44 years of age residing in the metropolitan Mexico City area and married or in stable union. 28 women hospitalized with confirmed diagnoses of ischemic heart disease, 22 with cerebrovascular accidents, 70 with pulmonary embolism or venous thrombosis, 33 with hypertensive cardiopathy, and 55 with other nonrheumatic heart diseases comprised the 201 cases. The 606 controls were women hospitalized with noncardiovascular acute illnesses who met the same requirements for inclusion or exclusion as the cases. Over 98% of the women in the study had been pregnant at some time. OC users were younger and better educated than nonusers. 30% of OC users and 26% of nonusers were smokers. The relative risk of nonrheumatic cardiovascular disease was 1.22 for past users of OCs, who included women using OCs until 1 month prior to the interview. The relative risk for women using OCs within 30 days of the interview (current users) was 1.24. The relative risk according to the estrogen dose was 1.79 for users receiving 40 mcg or less, but paradoxically doses of over 40 mcg decreased the risk to .75. The risk was 1.35 after 1 year of use of OCs, .96 from 12-18 months of use, and 1.34 after 48 months of use. The relative risk was .95 for ever users of OCs aged 20-29 years, 1.38 for those aged 30-39, and 1.48 for those 40-44. Among current users the relative risks were 1.19 for those aged 20-29, .84 for those aged 30-39, and 3.83 for those aged 40-44. The relative risks for ever users and current users respectively were 1.65 and 2.01 for ischemic heart disease and cerebral vascular accidents; 1.40 and 1.43 for pulmonary embolism and venous thrombosis; .85 and .71 for hypertensive cardiopathy; and 1.09 and 1.91 for other cardiovascular diseases. Users and nonusers of OCs had the same access to medical services. Observed differences in the ages and educational levels of users and nonusers were not a source of bias because cases and controls were paired by age and education. The results demonstrated that Mexican women in the Valley of Mexico who use OCs have a statistically significant elevated risk of developing nonrheumatic cardiovascular disease. In declining order of risk are cerebral vascular accident, ischemic heart disease, and pulmonary embolism and venous thrombosis. The risk is present from the 1st days of OC use and in use of OCs containing less than 40 mcg of estrogen. The risk increases with the age of users but not with smoking.
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PMID:[Oral contraceptives and cardiovascular diseases morbidity]. 373 40

Focus in this discussion of pulmonary embolism is on the following: risk factors (age, heredity and blood type, obesity, estrogen and oral contraceptive use/pregnancy, cardiovascular disease, cancer, and other risk factors); pathophysiology and presenting symptoms; laboratory procedures and findings (radiography, electrocardiography, lung scanning, and evaluation of lower extremity veins); treatment modalities (heparin therapy, thrombolysis, and surgery); and prevention. Pulmonary embolism may be the primary cause or a major contributory cause in as many as 200,000 deaths per year in the US. Most of these deaths occur in patients in whom the diagnosis is not suspected and, thus, not treated. The mortality rate for untreated pulmonary embolism is approximately 30%. 90% of patients survive the initial embolic event, but the correct diagnosis is made in no more than 2/3 of cases. Risk factors for the development of deep venous thrombosis are based upon the Virchow-Aschoff postulates, which include: trauma or disruption of the vein wall; stasis of blood flow in the veins; and increased coagulability of the blood. More than 85-90% of all pulmonary emboli originate from deep venous thromboses in the popliteal and femoral deep veins. Other important, although less frequent, sites of origin of venous thromboembolism include the pelvic veins, the renal and hepatic veins, the axillary veins in the upper extremities, and the right atrium. Accurate diagnosis and effective prevention and treatment depend on the clinician's awareness of risk factors for development of deep vein thrombosis. Estrogen may accelerate intimal proliferation in arteries and veins, and it may also increase permeability of venous vascular endothelium. The risk of thromboembolism increases as the dose of estrogen increases. Both pregnancy and oral contraceptive use significantly decrease venous tone and the velocity of blood flow in the calf of the leg. Appropriate treatment includes thrombolytic therapy for patients with massive pulmonary embolism, which results in hypotension or shock. Anticoagulant therapy with herapin followed by an oral anticoagulant is the primary treatment for most patients with submassive emboli in which there is less cardiovascular compromise. When thrombolytic therapy is used, it should always be followed by anticoagulant therapy. Prevention of primary or recurrent deep vein thrombosis is directed toward improving venous blood flow and reducing hypercoagulability.
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PMID:Pulmonary embolism: incidence, diagnosis, prevention, and treatment. 398 Feb 63

The purpose of the study was to assess the clinical value of echocardiography in a coronary care unit. 133 patients admitted for an acute cardiovascular disorder were examined by a mobile echocardiograph. 83 patients had an acute myocardial infarction, 8 extracardiac chest pain, 6 unstable angina pectoris, 6 acute pulmonary embolism and 16 other acute cardiovascular diseases. 14 patients were excluded from the study because of poor image quality. Echocardiography was found most advantageous in solving the following clinical problems: 1) early diagnosis of acute myocardial infarction (probably the earliest of all available methods); 2) immediate and precise diagnosis of complications in myocardial infarction; 3) differential diagnosis of chest pain; 4) detection of left ventricular thrombi (the most useful method for this purpose); 5) differential diagnosis of other acute cardiovascular diseases (pulmonary embolism, aortic root dissection etc.).
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PMID:The role of echocardiography in a coronary care unit. 405 18


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