Tỷ lệ thuyên tắc động mạch phổi ở bệnh nhân nội trú tại viện tim mạch việt nam trong năm 2016

PULMONARY EMBOLISM

CLINICAL FEATURES OF IN-PATIENTS AT VIETNAM
NATIONAL HEART INSTITUTE

GROUP: HANOI MEDICAL UNIVERSITY
PHẠM MINH TUẤN, MD,PhD
TRẦN TIẾN ANH
NGUYỄN QUỲNH ANH
TRẦN THỊ THUỲ LINH
LÊ MINH THẮNG
NGUYỄN DOÃN TUẤN


OUTLINE
1. PE: Background
- Epidemiology
- Risk factors
- Pathophysiology
- Diagnosis
2. Our study:
- Object
- Method
- Results
- Conclusion


BACKGOUND

Epidemiology
- PE: the most severe presentation of DVT

- It is the third most frequent cardiovascular disease with an overall
annual incidence of 1-2/1000 people
- Difficult to determine: remain asymptomatic or be lethal in the acute
phase


Epidemiology
7%

34%
59%

death resulting from PE and undiagnosed during life
presented with sudden fatal death
correcly diagnosed during life

(2014 ESC Guidelines)


RISK FACTORS
- PE may or may not have any risk factors
- List of predisposing factors:
- Major trauma
- Surgery
- Immobilisation
- Pregnancy
- Oral contraceptive
- Hormone replacement therapy
- Cancer
- Infection

- Blood transfusion/Erythropoiesis-stimulating agents


Pathophysiology


DIAGNOSIS STRATEGY


OBJECT
OBSERVE & DESCRIBE CLINICAL FEATURES OF IN-PATIENTS DIAGNOSED WITH
PULMONARY EMBOLISM

METHOD
OBSERVATION STUDY - CROSS-SECTIONAL STUDY
LOCATION: CICU department, Vietnam National Heart Institute
DURATION: September 2015 to September 2016
Found: 14 patients diagnosed with PE


GENDER DISTRIBUTION

43%
57%
Male

Age distribution
Mean

57 ± 18,26 yrs

Max

86

Min

27

Female


RISK FACTORS

10%
Within 4 weeks after surgery
Cerebral infraction
BMI>24
Hypercholesterolaemia
unknown

15%

55%

15%
5%


CLINICAL PREDICTION RULE for PE

WELL rule

1

GENEVA score

1

2

11

1

12

High probability

Moderate probability

Low probability


CLINICAL SIGNS
1

13

0.75

10
8

0.5

4

0.25
2
0

1
SHOCK

1
SYNCOPE HEART BEAT >100 DYSPNOEA

CHEST PAIN

FEVER

HEMOPTYSIS


- ARTERIAL BLOOD GAS
Present

Absence

pH > 7,45

46%

54%

pO2 < 80 mmHg

77%

23%

pCO2 <35 mmHg

62%

38%

Lactate > 2mmol/L 38%

62%

- D-dimer increase in 100% cases
- Doppler ultrasound of the lower limbs: presented in 50% patients


Echocardiograms
PH
0

0.25

0.5

20-50 mmHg

0.75

1

>50 mmHg

RV dilation
0

0.25
=<20 mm

0.5

0.75
>20 mm

COMPUTED TOMOGRAPHIC PULMONARY ANGIOGRAPHY: (CT)
image of thrombosis in 100% patients

1


- ARTERIAL BLOOD GAS

Present

Absence

pH > 7,45

46%

54%

pO2 < 80 mmHg

77%

23%

pCO2 <35 mmHg

62%

38%

Lactate > 2mmol/L 38%

62%

- D-dimer increase in 100% cases
- Doppler ultrasound of the lower limbs: presented in 50% patients

CONCLUSION
- Certain cases does not have any predisposing factors

- Dyspnoea, heart beat > 100, and chest pain are the most
common signs of PE
- D-dimer: high sensitivity to diagnose DVT
Once have suspected with DVT, always think of PE
- 85% patients with PH in echocardiograms have the image of
thrombosis on CT-scan


THANK YOU VERY MUCH