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

Thromboembolism is presently the third most frequent cardiovascular disease, with an incidence of deep venous thrombosis of 800,000 cases a year in the USA. The clinical diagnosis of the condition is difficult and noninvasive procedures are poorly reliable, which makes the diagnosis and treatment of deep venous thrombosis appropriate in the patient with clinically suspected pulmonary embolism. Color-Doppler US is now replacing phlebography in the diagnosis of deep venous thrombosis. Proximal deep venous thrombosis is always at high risk for embolism (50%). Isolated calf thrombi may spread into proximal veins and thus cause severe embolism. Therefore, the early detection of thrombus site and extent and a timely treatment before embolism are of the utmost importance. Color-Doppler US is a noninvasive technique which can show deep venous thrombosis with 95% sensitivity in the proximal and 55% sensitivity in the distal districts in asymptomatic patients. This examination must be used not only to confirm a diagnostic suspicion of deep venous thrombosis, but also to screen high-risk patient and to monitor distal thrombosis. In the secondary prophylaxis of pulmonary embolism, the radiologist must perform a mechanical interruption of inferior vena cava by positioning a caval filter. Caval filters can be temporary or definitive; standard indications for caval filter positioning are a contraindication to anticoagulant therapy and the onset of pulmonary embolism in spite of anticoagulant drugs. A further indication is the presence of floating thrombi in the femoroiliac-caval trunk. Multidisciplinary groups including the hematologist, the radiologist and the clinician should plan the diagnostic and therapeutic approach and participate in the decision-making process. In our department, from January, 1992, to June, 1995, sixty-five caval filters were positioned in 62 patients selected out of 260 candidates. Three complications only were observed; one patient had recurrent pulmonary embolism and three patient had caval thrombosis spreading beyond the filter. In 198 patients in whom no caval filter was implanted, pulmonary embolism did not recur. At present, the role of the radiologist is markedly changing, especially in the management of this condition. On the one hand, radiologists must diagnose thromboembolism as a whole and not only its pulmonary evidence; on the other hand, they play a major operational and interventional role in the treatment of thromboembolism patients.
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PMID:[Pulmonary thromboembolism and diagnostic imaging: integration of techniques and methods]. 896 76

The cardiovascular risk associated with use of combined oral contraceptives (OCs) was assessed through a review of the English-language literature published from 1967 (when low-dose OCs were introduced in the US) and June 1997. Data were organized by cardiovascular end point (myocardial infarction, stroke, venous thrombosis and pulmonary embolism), study design, estrogen dose, and type of progestogen. As a result of the rarity of cardiovascular disease in young women, few such events are available for analysis, even in large cohorts of women. However, the review suggested that the overall risk for cardiovascular disease is substantially lower with current OC preparations containing 50 mcg of estrogen or less, including those that contain the new progestogens, than with older OCs containing high doses of estrogen. Preliminary case-control studies indicate that the risk of myocardial infarction is lower among users of OCs containing desogestrel and gestodene while that of venous thromboembolism may be elevated with these progestogens compared with levonorgestrel. Of concern is emerging evidence that the newer OCs have an attenuated acute prothrombotic reaction with cigarette smoking compared to older formulations. For stroke as well, OC users who smoke are substantially more susceptible than nonsmoking users. Every effort should be made to encourage smoking cessation among potential or current users of OCs.
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PMID:Epidemiology of oral contraceptives and cardiovascular disease. 984 12

To evaluate the utility of the alveolar-arterial (A-a) oxygen gradient in the diagnosis of acute pulmonary embolism (PE), a retrospective analysis was done of consecutive emergency department patients who underwent pulmonary angiography for the presumed diagnosis of acute PE. Patients were categorized into two groups depending on the presence or absence of prior cardiopulmonary disease. Arterial blood gas samples were chosen for analysis only if obtained when the PE first was suspected clinically (before lung scans or angiograms) and the patient was breathing room air. A total of 152 patients met all study criteria; 59 patients (39%) had angiographically documented emboli. In comparison with the study patients in whom PE was excluded, there was no significant difference in mean PaO2 (64 v 67 mm Hg) or A-a gradient (39 v 36 mm Hg). Various combinations of the A-a gradient and blood gas levels failed to exclude PE in more than 35% of patients with no prior cardiovascular disease and in 25% of patients with prior cardiovascular disease. The A-a gradient did show a linear correlation with the severity of the PE, as assessed by the PaO2 (r = -0.87) and pulmonary artery mean pressure (r = 0.63). These results indicate that the A-a oxygen gradient, in combination with blood gas levels, may contribute to the formulation of a clinical assessment. However, these laboratory parameters are of insufficient discriminant value to permit exclusion of the diagnosis of PE.
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PMID:Use of the alveolar-arterial oxygen gradient in the assessment of acute pulmonary embolism. 967 44

The annual risk of death in the US from cardiovascular disease attributable to low-dose combination oral contraceptives (OCs) was estimated through use of data from studies published in 1980-1997 and from age-specific mortality rates for 1993 and 1994. Four cardiovascular disease categories were included: myocardial infarction, venous thromboembolism and pulmonary embolism, ischemic stroke, and hemorrhagic stroke. The overall risk of death from cardiovascular disease among nonsmoking users of low-dose OCs is 0.06/100,000 women in the 15-34 year age group and 3.03/100,000 women in the 35-44 year age group. For young nonsmokers, the excess mortality risk associated with OC use is smaller than the risk of death from pregnancy, whether terminated by abortion or carried to term. Among OC users who smoke, the risk of cardiovascular mortality is 1.73/100,000 in 15-34 year olds and 19.4/100,000 in women 35-44 years old; however, 97% and 85% of this risk, respectively, is composed of the combined OC-smoking risk. Among smoking OC users over 35 years of age, the excess risk of death from OCs exceeds the risk of death from pregnancy. Young nonsmokers raise their risk of death from cardiovascular disease by less than 10% (0.60-0.65/100,000) by using OCs, while young women who do not use OCs increase their risk of death by 260% (0.60-1.57/100,000) by smoking cigarettes. For older women, the corresponding increases are 95% among nonsmoking OC users and 315% among smoking nonusers. These estimates indicate that women over 35 years of age who smoke should not be permitted to use either low- or high-dose OCs because of the excess attributable risk of death from cardiovascular disease.
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PMID:Estimates of the risk of cardiovascular death attributable to low-dose oral contraceptives in the United States. 991 11

Observations of the pharmacology of tamoxifen and related compounds have lead to the concept of selective estrogen receptor modulators (SERMs). This new class of drug displays estrogen agonist or antagonist effects in a tissue-dependent manner and appears to offer an alternative to hormone replacement therapy for the prevention and treatment of osteoporosis and cardiovascular disease in postmenopausal women. Moreover, the estrogen antagonist actions of SERMs on breast tissue may also provide a protective effect against breast cancer. Although tamoxifen therapy reduces plasma cholesterol levels and maintains bone density, it is also associated with an increased risk of endometrial cancer, pulmonary embolism and deep vein thrombosis. This has lead to the development of newer SERMs which will hopefully lack these adverse effects of tamoxifen. These compounds promise a new era of disease prevention in the aging woman and their therapeutic potential is currently being evaluated in large-scale clinical trials.
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PMID:Clinical pharmacology of selective estrogen receptor modulators. 1040 33

Pulmonary embolus is a significant aspect of thromboembolic venous disease which globally is the third most important cardiovascular disorder. There are several methods of primary prevention to decrease morbidity and mortality related to this disease. This article consists of a review of the most current methods of prophylaxis followed by practical recommendations for surgical, medical and obstetric patients.
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PMID:[Strategies for prevention of pulmonary embolism during at-risk surgeries and in the medical environment]. 1090 43

Obesity increases the risk of metabolic complications such as diabetes, dyslipidemia, systemic hypertension and cardiovascular disease. These are mainly responsible for the increased mortality of obese people. Other metabolic consequences of obesity are: gallstones, steatosis of the liver and the polycystic ovary syndrome. Beside the body mass index the distribution of body fat is important. Centralized obesity, as measured by the waist-to-hip circumference ratio (WHR), is associated with increased mortality and morbidity. Insulin resistance and hyperinsulinaemia seem to play a central role in the pathogenesis of this association. Obesity has not only metabolic complications. There is a relationship between obesity and impaired respiratory function. Furthermore is obesity a risk factor for osteoarthrosis of the knee, the hip and even the hand and for pulmonary embolism and venous thrombosis. Obesity can also lead to psycho-social problems such as depression, social discrimination and isolation.
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PMID:[Consequences and complications of obesity]. 1102 85

Pulmonary embolism (PE) represents the third more frequent cardiovascular disease following the acute coronary artery disease and stroke. The most important predisposing clinical condition for PE is represented by the deep-vein thrombosis. The clinical diagnosis of PE has a very low accuracy; so the clinical suspect has to be necessarily directed towards the performance of diagnostic procedures. Among the most used procedures, the echocardiography has a diagnostic role but also a prognostic one. Moreover, it offers precious informations useful to perform the most suitable treatment. The echocardiography features which suggest the presence of pulmonary embolism are: right ventricle and atrium dilatation, right ventricular hypokinesia, systolic flattening of the interventricular septum, tricuspid regurgitation, pulmonary artery dilatation, disappearance or reduction of the inspiratory collapse of the inferior vena cava and presence of eventual embolic sources. According to the involvement degree of right ventricular function, it is generally possible to identify a different survival. The subgroup of patients with moderate or severe right ventricular dysfunction shows a high in hospital and within 1 year death rate. For this reason the right ventricular dysfunction degree together with the hemodynamic stability, are the most important parameters in the therapeutic choice. If there is no right ventricular dysfunction a treatment with heparin is indicated. In presence of right ventricular dysfunction and hemodynamic instability, the thrombolytic treatment is necessary. If the patient is hemodynamically stable, a transesophageal echocardiography is recommended; in case of central thrombosis the thrombolytic therapy or surgery are needed, while if no embolic material is shown the heparin treatment is advisable.
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PMID:[Cardiologic diagnosis of pulmonary embolism: echocardiography]. 1125 35

The objective of this article is to illustrate the significant relationship between fibrinogen and thrombophilia, the tendency toward clot formation. This deserves attention because thrombus formation leads to disease states such as pulmonary embolism, peripheral vascular disease, and cardiovascular disease (CVD). The latter holds the distinction of being the leading cause of mortality among the U.S. population. Elevated levels of plasma fibrinogen have been correlated with increased risk of ischemic events. Its relationship is even stronger than that of increased total cholesterol. Many studies have demonstrated that fibrinogen is a potent predictor of coronary artery disease, and it is also positively associated with stroke. For all of its predictive power, fibrinogen's use as a yardstick for cardiovascular risk has not gained widespread acceptance. The problem with fibrinogen as a clinical tool for predicting coronary events is that laboratory measurement is not standardized, and specific clinical interventions to lower fibrinogen levels are not available. Fibrinogen is also an acute phase reactant. It fluctuates with the onset of inflammatory stares. When there is a change in the structure of the fibrinogen molecule, either by hereditary or acquired conditions, there can be dramatic effects, or none at all. Since fibrinogen plays several roles in maintaining hemostatic balance, abnormalities in molecular composition can be reflected in various ways, including thrombus formation.
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PMID:Fibrinogen and thrombophilia. 1176 Aug 26

The views on the effects of postmenopausal hormone-replacement therapy (HRT) on cardiovascular disease have moved from one end of the spectrum to the other over the past decades. The presumed beneficial effects of HRT on arterial cardiovascular disease were based on observational findings and have led to the widespread use of these agents. However, recent large-scale randomised, placebo-controlled trials have demonstrated that HRT in women with a history of arterial diseases initially increases the risk of recurrent disease, while offering no benefit in the long term. Healthy postmenopausal women on HRT have an increased risk of arterial cardiovascular events compared with those taking placebo (relative risk 1.29; 95% CI: 1.02-1.63). Finally, the risk of venous thrombosis and pulmonary embolism is increased with the use of HRT. These results demonstrate that bias and confounding can play an important role in observational research and underscore the importance of randomised, placebo-controlled trials when studying the efficacy of drugs.
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PMID:[Adverse cardiovascular effects of postmenopausal hormone replacement therapy]. 1247 50


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