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

Not only is RVH difficult to diagnose electrocardiographically but it is frequently mimicked by true posterior infarction. The R/S-amplitude ratio in lead V1 and the S wave in lead V5 are the most useful indices of RVH. The ECG in chronic lung disease can be distinguished from that in RVH and is more often confused with that of anterior infarction. The ECG changes found in pulmonary embolism are the same as those found in RVH but they are transient; they are more easily interpreted by means of serial ECGs. In conjunction with clinical data the ECG can be used to predict the severity of pulmonary valve stenosis.
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PMID:Electrocardiography: right ventricular hypertrophy. 15 61

The authors report 6 cases of acute respiratory failure complicating chronic bronchial and lung disease admitted to hospital with the diagnosis of: heart disease, 3 cases, pulmonary oedema, pulmonary embolism, atrial flutter; status asthmaticus : one case; neuro-psychiatric disease : 2 cases (toxic coma and agitation). The authors emphasize the frequency of chronic bronchial disease and recall the signs of acute decompensation discussing the possible difficulties in diagnosis and the therapeutic implications.
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PMID:[Deceptive and revealing clinical forms of acute respiratory insufficience in chronic bronchopneumopathies]. 19 94

The diagnosis of mislaying forms of pulmonary embolism, where even angiography was not pathognomonic, induced the use of a phlebography on lower limbs in patients where this diagnosis was suspected. The revelation of a distal thrombo-phlebitis and even more so an iliocaval one, becomes a major value when the clinical and paraclinical data remained arguable. The comparative study of diagnostic usual clinical and paraclinical elements (radiographies, E.C.G., gasometries and scintigraphies) confirmed, in 22 patients, the value of phlebography. On a pneumological background, it is useful to perform this examination, most of the time : a) on patients over 55, when a cardiorespiratory decompensation remained unexplained in a patient with chronic respiratory insufficiency, or even an unproved hemoptysis; b) but mostly before 55, in case of painful pneumopathy above all if it is bilateral and recurring, or in case of paroxysmal bronchospasm without atopic ground, when a belated asthma could be thought of. Finally vascular tests induced the fitting in situ of a clamp or "umbrella" in the vena cava in 7 patients out of 22.
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PMID:[Value of vascular tests in the diagnosis and therapeutical indications of pulmonary embolism on a pneumological background (author's transl)]. 47 76

The authors described the case of a 49-patient suffering from obstructive broncho-pneumopathy and ischemic myocardiopathy complicated by multiple pulmonary embolism. The clinics were dominated by signs of major hepatic deficiency and of intravascular disseminated coagulation with fibrinolysis. The clinical and biological parameters evoking pulmonary embolism in that intricated chart were discussed.
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PMID:[Hepatic lesions and coagulation disorders in pulmonary embolism: a clinico-pathological case]. 108 55

Left heart diseases, in particular mitral stenosis, are often associated with anatomic and functional alterations of the lung. According to the pulmonary structures involved they could be named chronic secondary intersticial and vascular lung diseases. Congenital heart diseases with pre- or post-tricuspid shunts are also often associated with anatomic and functional alterations of the lung. This condition also constitutes a chronic secondary vascular lung disease (atrial septal defect) or a chronic primary vascular lung disease ( ventricular septal defect, patent ductus arteriosus). Primary lung diseases (interstitial pulmonary fibrosis, pulmonary emphysema, recurrent pulmonary embolism) are often associated with right ventricular hypertrophy with or without dilation, a condition commonly named chronic cor pulmonale. On the whole the interrelationships between heart and lung diseases are as follows: a) anatomic and functional alterations of the lung due to left heart diseases are mediated through pulmonary venous hypertension; b) anatomic and functional alterations of the lung due to congenital heart diseases are mediated through the increased pulmonary blood flow with or without transmission of the systemic blood pressure to the pulmonary vasculature, and c) anatomic and functional alterations of the right ventricle due to primary or secondary lung diseases are mediated through arterial pulmonary hypertension. In summary, the interrelationships between heart and lung diseases are mainly mediated through the pulmonary venous or pulmonary arterial hypertension.
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PMID:Cardiac and pulmonary diseases. A pathophysiologic interelationship. 113 Sep 7

Animal studies have demonstrated that thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) is accelerated and that bleeding is reduced when rt-PA is infused over a short period. Previous clinical studies in patients with venous thromboembolism have shown that rt-PA is an effective thrombolytic agent when administered by continuous infusion over 2 to 24 hours. Clinical experience of bolus rt-PA administration in patients with massive acute pulmonary embolism (PE) is, however, limited. A prospective open study was conducted in which 54 patients with massive PE (Miller index > or = 20 of 34) received a 10-minute infusion of rt-PA at a dose of 1 mg/kg. Perfusion lung scanning was used to assess the change in pulmonary perfusion after drug administration. At 48 hours and 10 days, the mean absolute improvements in the perfusion defect were 11 and 31%, respectively. In addition, a significant clinical improvement occurred within 2 hours in 11 of the 15 shocked patients. Five patients died (9%) as a result of persistent shock (3 patients), neurologic damage (1 patient) or intracranial bleeding (1 patient). Major bleeding occurred in 8 patients (15%). Long-term follow-up information was available for 44 of the 49 discharged patients: 2 had died and 12 (27%) complained of persistent exertional dyspnea, 7 of whom had an associated heart or lung disease or chronic thromboembolism at admission. These results suggest that a bolus regimen of rt-PA could provide a convenient approach to thrombolytic therapy in patients with massive PE.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effectiveness and safety of bolus administration of alteplase in massive pulmonary embolism. 144 21

The 188 patients with pulmonary embolism were treated at the Clinic for Pulmonary Diseases of the M.M.A. in the period 1979-1989. Clinical symptoms and signs, diagnostic procedures and therapy of pulmonary embolism are analysed. The diagnosis is difficult and is suggested by the predisposing factors, symptoms and signs of the disease as well as indirect diagnostic procedures. The contribution of perfusion lung scintigraphy is precious. Deep venous thrombosis of the lower extremities, the source of pulmonary embolism, is commonly clinically absent. The complete cure without complications was achieved in 156 (83%) patients. The most common complications were: early and late recurrences, hematuria and peptic bleeding. The lethal outcome occurred in two cases of basic disseminated malignant disease.
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PMID:[Personal experience in the diagnosis and treatment of pulmonary embolism]. 221 1

Pulmonary embolism (PE) leads to an abnormal alveolar deadspace that is expired in synchrony with gas from normally perfused alveoli. This feature of PE separates it from pulmonary diseases affecting the airways, which are characterized by nonsynchronous emptying of compartments with an uneven ventilation/perfusion relationship. An analysis of the single breath test (SBT) for CO2, SBT-CO2, focusing on the late tidal expirate, was made in order to evaluate the feasibility to use the SBT-CO2 for the diagnosis of PE. The test was evaluated in 38 patients with suspected PE where pulmonary angiography showed that nine had PE and 29 did not. It was also tested in a reference population consisting of patients with normal lung function, obstructive lung disease and interstitial lung disease. Previously suggested gas exchange measurements for the diagnosis of PE, ie, the physiologic deadspace fraction, VDphys/VT, and the arterial-to-end-tidal CO2 gradient, P(a-E')CO2, were also evaluated in the groups. SBT-CO2 achieved a nearly complete separation between the patients with PE and those without. The other measurements, however, showed a substantial overlap between patients with PE and those with obstructive or interstitial lung disease. The SBT-CO2 is simple and potentially widely available and warrants further study as a routine technique for the diagnosis of PE.
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PMID:Diagnosis of pulmonary embolism based upon alveolar dead space analysis. 275 19

The natural history of pulmonary embolism is described, together with the physiopathologic alterations and the clinical manifestations of this disease, correlating these with the various patterns of pulmonary perfusion usually found by lung scintigraphy with 99mTc-MAA in patients with thromboembolic lung disease. By using data found in the literature, the operating characteristics (sensitivity, specificity, and accuracy) and the predictive values of the different scintigraphic patterns, were calculated for populations with different prevalences of pulmonary embolism. It is concluded that perfusion lung scintigraphy is a non-invasive, objective and fast procedure, very sensitive to alterations of the regional blood flow, but that is not specific for embolism. In some cases it can replace pulmonary angiography but in others, its results may indicate the performance of invasive procedures.
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PMID:[Scintigraphic criteria for the diagnosis of pulmonary embolism]. 293 4

Total lymphoid irradiation was administered to 32 patients with intractable rheumatoid arthritis. Twenty-four patients showed at least a 25% improvement in 3 of 4 disease activity parameters, which persisted during the followup period of up to 48 months. Eight of the 32 patients required adjunctive immunosuppressive drug therapy to maintain improvement. Four patients died after total lymphoid irradiation; the causes of death were acute myocardial infarction (1 patient), pulmonary embolism (1 patient), and rheumatoid lung disease complicated by respiratory infection (2 patients). After therapy, patients exhibited a prolonged reduction in the number and function of circulating T helper cells.
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PMID:Long-term followup of rheumatoid arthritis patients treated with total lymphoid irradiation. 294 53


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