Management of Thromboembolism (Pulmonary Embolism) in Coronary Cardiac Unit

Faiza Naeem* and Saleha Sadeeqa

Women University, Lahore, Pakistan, Email: faizanaeem12@hotmail.com and condition of pulmonary embolism.

Keywords: Pulmonary Embolism; Hypercoagulability; Venous Stasis; Occlusion

Introduction

Venous thromboembolism (VTE) including pulmonary embolism (PE) & Deep vein thrombosis (DVT) is the major source of morbidity as well as higher mortality rate [1]. Primary pulmonary thrombi commonly occur in upper lobe of human lungs than the lower lobes, although thromboemboli either small or large can be more numerous in lower lobes of lung if they happen [2].

Multiple studies showed reported rates for pulmonary embolism recurrence ranging from 2 % to 50 % [3].

Epidemiologic prospective data evaluated a frequency of nearly 4% pulmonary thromboembolism. In clinical manifestation, unexplained dyspnea persistent nature, greater perfusion defects are also seen. Parenchymal signs including scars, mosaic pattern for perfusion, bronchial anomalies and focal opacities are also evaluated [4]. VTE is 3rd prominent disease associated with cardiovascular system in United States. Thrombosis frequency increases along with age and 2 folds higher in people older than 65 yrs [5].

Risk factor for venous thrombosis development as well as propagation includes increased coagulability, venous stasis and endothelial injury. Smoking will increase the plasma fibrinogen level and it will activate the pathway for intrinsic coagulation by anoxia or endothelial damage. Diabetes, physical inactivity and obesity all are connected with greater coagulation and lower fibrinolytic potential which can cause venous stasis. Lipids, predominantly elevated lipoprotein or triglycerides (TGs), increases coagulation and interact with fibrinolytic cascades [6]. Venous stasis has shown to improve the formation and propagation of intravascular deep vein thrombosis (DVT) [7].

Spiral CT angiography evidenced as effective in the recognition of PE in pulmonary arteries up to segmental level [8]. Treatment with heparin and streptokinase or heparin alone (both thrombolytic therapies) can decrease the death rate of acute stage of massive pulmonary embolism [9]. Anticoagulation therapies are capable of improving the patient outcome. Thrombolytic therapy in acute stage and use of inferior vena cava filters both are effective in treatment of PE [10]. Patients diagnosed with chronic stage of PE are more prone to Troponin level is raised and pulmonary embolism is confirmed by CT pulmonary angiography. Other parameters of patient profile are tabulated in Table 1.

surgical therapeutic interventions [11].

Case Presentations

A 42-year male having 66kg weight presents with complains of Chest pain and nausea. He was suffering from Chest pain from 3 hours along with rapid breathing. He smokes 7-8 cigarettes per day. He frequently uses fried food in his diet.

Discussion

Pulmonary embolism remains an imperative medical problem with greater mortality rate [12]. Venous thromboembolism (VTE) is a blood clot in veins which is highly predominant health problem causing disability and raising the death rate. This patient was complaining about the chest pain which was due to blockage by embolus in pulmonary region. He was using fried food more frequently and he smokes 7-8 cigarettes per day. Both of these are contributing etiological factors for development of pulmonary embolism. Most of the studies showed the effect of smoking on function of platelets resulting in the thrombus formation [13]. Lipids or lipoproteins accelerate the thromboembolism by prostaglandins which are synthesized by fatty acids resulting in activation of platelet and coagulation cascade [14].

Symptomatically, Patient was treated with thrombolytic drugs and further life style modifications. Thrombolytic drugs have shown proper effect in patient for thrombolysis and relieving the chest pain by Glyceryl Trinitrate (sustac). Life style modifications including stoppage of smoking and fried food intake can help this patient from recurrence of thromboembolism. Metoclopramide 10mg was added to his treatment for nausea by pharmacist. As patient is suffering from co morbidity as diabetes so it is mandatory to evaluate the glucose level. As regular glucose monitoring showed maintained glucose level after use of vidagliptin 50mg. So, the patient is managed properly by doctor’s recommendations as well as by pharmacist interventions.

Conclusion

In this case history, the patient was suffering from PE and DM type 2. Now-a-days, PE is leading cardiovascular event so aim was to treat chest pain and embolus formation in pulmonary region. He was treated with thrombolytic therapy. Patient was stable after treatment with thrombolytic agents.