Riyadh: Dr. Hassan Muhammad Sandakji
In its current August 5 issue, the British Medical Journal BMJ presented a review by a group of North American researchers of pulmonary embolism. The researchers were keen to provide an advanced scientific review of the latest findings of the best diagnostic and treatment methods for cases of pulmonary arterial thrombosis in an easy-to-practical way in clinical application, and in understanding the patients’ response to them.
The researchers also presented a review of the points of medical disagreement and controversy related to the best methods of diagnosing and treating them in a number of different medical and health conditions in which the risk of pulmonary arterial thrombosis is high, which at the same time requires a treatment approach that fits into those different disease and health conditions on their own, such as pregnancies and beyond. Childbirth, cancerous injuries, post-surgical operations, and cases of recurrent pulmonary embolism, and others.
Deep vein thrombosis
The researchers included a review of more than 360 previous studies on pulmonary thrombosis (PE) and deep venous thrombosis (DVT). It seems that the researchers succeeded in this aim, as evidenced by the praise of the editorial board of the British Medical Journal by describing this study as a “State of the Art Review”, meaning that it is a medical scientific review that provides the best results in this regard.
The medical community translates a condition in which blood clots form in the pulmonary arteries as “pulmonary thrombosis” or “pulmonary embolism.” The medical community links between venous thromboembolism (or deep vein thrombosis) with pulmonary arterial thrombosis (or pulmonary thrombosis) for several reasons, the most important of which is that the majority of the sources of these blood clots that cause pulmonary arterial clots are actually blood clots that formed and clotted in deep veins, Then it found its way to the pulmonary arteries, causing them to become blocked. As a practical clinical application, the researchers said: “VTE includes both deep vein thrombosis and pulmonary thrombosis. It is believed that the transmission of deep vein thrombosis, which is in the lower extremities, and their access to the pulmonary arteries is the most common mechanism of pulmonary thrombosis.
In their first statements when presenting the study, the researchers recalled: “A pulmonary embolism is a common, fatal cardiovascular disorder that must be diagnosed and treated promptly. It is the third most common cardiovascular disorder. ”
The researchers reported that despite comprehensive medical studies on rates of venous thrombosis and pulmonary thrombosis, and a group of risk factors for infection, public awareness about them is weak compared to other conditions with similar prevalence of venous thrombosis and pulmonary thrombosis. They added, “This was demonstrated in an international survey of more than 7,000 people in 9 countries. The results showed that half of those included in the study had no awareness of venous thrombosis and pulmonary thrombosis, or the risk factors for any of them.
Risks of stroke, and
they mentioned that the advanced accuracy of modern imaging methods has led to more accuracy in diagnosing pulmonary thrombosis, which has more than doubled hospital admission rates due to it over the past ten years.
They explained that advancing age increases the risk of developing a pulmonary clot, specifically by several times, when comparing those under the age of forty to those over the age of sixty. Among people between the ages of 45 and 80, men are more likely to have a lung stroke than women. And among those under the age of 45 and over 80, women are more likely to have it than men. This is what the researchers commented by saying: “It is possible that this interaction with age and gender is related to the estrogen hormone and risk factors associated with early pregnancy and the life expectancy of women in advanced ages.”
The researchers also showed that those who had previously had a pulmonary arterial thrombosis were at greater risk of recurring infection, especially in the months following their first occurrence. They added: “50 percent of venous thromboembolism cases are associated with a transient RF risk factor, such as recent surgery or hospitalization due to a medical condition. And in 20 percent of it is linked to cancer. The rest is related to little or no risk factors and is therefore classified as “Unprovoked”.
Advanced diagnostic steps
from the clinical reality of patients, and because of the potential threat to life safety, there is a need to initiate a thorough clinical evaluation to know the extent of the condition of pulmonary thrombosis, because some of its symptoms are similar to those of other conditions that are less serious and less threatening to the safety of life.
The researchers said their summary is that there are three recent and very important developments in the diagnosis of pulmonary thrombosis and venous thrombosis, which made a logical clinical sequence in the medical treatment to diagnose the extent of these dangerous cases of lung clots. These are: First: the use of Clinical Probability Scores, and second: the use of practical translation of the results of the D – dimer analysis. And third, the use of accurate diagnostic radiography.
> In the aspect of the first diagnostic step, that is, the extent of clinical suspicion of the presence of a pulmonary or venous thrombosis, the clinical probability assessment is used when the patient attends and expresses a complaint of symptoms, and before conducting further investigations. That is, to determine the “Pre-Test Probability”. To clarify, a person may complain of some symptoms that may be caused by a pulmonary clot or any other condition that is not dangerous to health. Here, this evaluation of the clinical likelihood scores for the presence of that pulmonary embolism. And upon noticing these high odds, work is being done quickly to complete the tests and start treatment very early.
As for when observing a patient’s low probabilities, the evaluation of clinical probability scores is useful in avoiding unnecessary examinations for him, and is also useful in giving a safe clinical explanation for any abnormal results of the analyzes (if they were performed for him). This other aspect is clinically important, because some test results may be positive, but not necessarily due to the presence of pulmonary or venous thrombosis. The researchers presented an example of this, a nuclear imaging examination of the ventilation-perfusion ratio in the lung (VQ Scan), which may show False Positive Result, especially when there is a decrease or increase in the level of risk by conducting a clinical likelihood score assessment. This has been confirmed by the results of medical studies that tracked the extent of the presence of a pulmonary clot using the Golden Diagnostic Test method, which is: direct pulmonary arteriography, that is, “pulmonary angiography”.
The evaluation of clinical probability scores includes observing the extent to which there are eight clinical variables associated with a higher risk of pulmonary embolism, namely: hypoxia, unilateral leg swelling, hemoptysis, previous venous thrombosis, recent undergoing surgery or injury Recent accidents, age over 50, use of female hormones, and tachycardia.
Clot monitoring and imaging
. In addition to the second diagnostic step, the D-dimer analysis tracks the extent of its presence in the blood. D-dimer is a small protein molecule that is produced and appears in the blood when a fibrinolysis occurs after its formation. It is true that an increase in the presence of D-Dimer may indicate the presence of a blood clot in any of the blood vessels in the body, but it may also increase in other conditions unrelated to the thrombus of blood clots. So the researchers said: “D-dimer analysis is a useful diagnostic tool. A negative result, with a low clinical likelihood, is useful to exclude a diagnosis of venous thromboembolism. However, the D-dimer test should not be used as a screening tool in patients who are not clinically suspected of developing venous thromboembolism. Physicians should assess clinical probability before ordering the D-dimer test.
> On the side of the third diagnostic step, radiography of suspected cases of pulmonary embolism, the researchers said what was summarized: “The historically golden diagnostic test is interventional pulmonary angiography. However, this interventional procedure was abandoned and the use of diagnostic radiography methods, which are lighter on the patient and give accurate results. They added: “Nuclear imaging of the ventilation-perfusion ratio in the lung and tomography of pulmonary angiography using dye are among the approved imaging tests used to diagnose pulmonary thrombosis. Both must be used in conjunction with likelihood scores and the D-dimer analysis test, to interpret the results accurately. Both false negative results and false positive results can be observed when the test results conflict with clinical probability scores. ”
Pulmonary thrombosis … risk factors and varying degrees of injury
> The medical community classifies the pathological and health factors that are associated with a person’s high risk of developing pulmonary and venous thrombosis into two categories: transient and permanent. In each category, the risk factors are classified into 3 degrees, in terms of the depth of their impact. They are:
> Strong risk factors:
– Fracture of the hip or leg
– Replacement of the hip or leg joint
– General surgery
– Major accident
injury – Spinal cord injury
> Moderate risk factors:
– Arthroscopic knee surgery
– Central Venous Lines
– Congestive Heart Failure or Respiratory Failure
– Hormone Replacement Therapy
– Oral Contraceptive Treatment
– Stroke Paralysis
– Previous Venous Thrombosis
> Poor risk factors:
– Bed rest more than 3 days
– Inactivity due to sitting in long road travel or air travel
– Advancing age
– Laparoscopic surgery
– Prenatal in pregnancy
– Varicose veins
Symptoms and signs that require
prompt medical assistance > A lung clot arises when a blockage occurs in one of the pulmonary arteries in the lungs by a blood clot. The pulmonary arteries are the ones that exit from the right part of the heart and supply the lung with blood, so that carbon dioxide is purified and supplied with oxygen. Often, this blockage is caused by a blood clot coming from clots that have formed in the deep veins of the legs, thighs, or pelvis.
Because blocking the pulmonary arteries with these clots of blood clots impedes blood flow to all parts of the lungs, it hinders the efficiency of the blood supply with oxygen, which may represent a real life safety threat, depending on the affected lung, the size of the clots, and whether the person has disease Pulmonary or cardiac in origin. However, making a correct diagnosis early and providing prompt treatment can greatly reduce the repercussions and complications of these dangerous conditions.
According to the Mayo Clinic researchers, among the most important symptoms of a pulmonary embolism is the following:
Shortness of breath. This symptom usually appears suddenly and always gets worse with effort.
Chest pain You may feel like you are having a heart attack. The pain is usually sharp and felt when you breathe deeply, and it usually prevents you from being able to take a deep breath. You may also feel it when you cough, bend or bend.
Cough The cough may produce bloody sputum or have streaks of blood.
The signs and symptoms that may appear in a pulmonary embolism include the following:
– Rapid or irregular heartbeat
– Lightheadedness or dizziness
– Pain or swelling of the legs or both, usually in the calf, as a result of deep vein thrombosis
– Skin moisture Or pale blue.
Therefore, it is worth seeking urgent medical aid if the person suddenly suffers from: unexplained shortness of breath, chest pain, or cough that contains bloody sputum.