Pulmonary Embolism : A Practical Guide for the Busy Clinician - 08/06/20

Doi : 10.1016/j.hfc.2020.03.004

Pablo Demelo-Rodriguez, MD, PhD ^a,^b,^c, Francisco Galeano-Valle, MD ^a,^b,^c, Andrea Salzano, MD ^d, Eweline Biskup, MD ^e,^f, Olga Vriz, MD, PhD ^g, Antonio Cittadini, MD ^h, Lorenzo Falsetti, MD, PhD ⁱ, Brigida Ranieri, PhD ^d, Valentina Russo, MD ^j, Anna Agnese Stanziola, MD, PhD ^k,^l, Eduardo Bossone, MD, PhD, FCCP, FESC, FACC ^m, Alberto M. Marra, MD, PhD ^h,^n,^⁎
^a Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle doctor Esquerdo, 46, Madrid 28007, Spain
^b Sanitary Research Institute Gregorio Marañón, Calle doctor Esquerdo, 46, Madrid 28007, Spain
^c Universidad Complutense de Madrid, School of Medicine, Spain
^d IRCCS SDN, Diagnostic and Nuclear Research Institute, Via Gianturco 131, Naples 80137, Italy
^e Department of Basic Medical College, Shanghai University of Medicine and Health Sciences, Shanghai 201315, China
^f Division of Internal Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
^g Heart Centre Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
^h Department of Translational Medical Sciences, “Federico II” School of Medicine, “Federico II” University of Naples, Via Pansini 5, Naples 80131, Italy
ⁱ Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, Ancona, Italy
^j Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, Naples I-80138, Italy
^k Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
^l Centre for Rare Respiratory Diseases, Monaldi Hospital, Via Leonardo Bianchi, Naples 80131, Italy
^m Division of Cardiology, Cardarelli Hospital, Via A. Cardarelli, 9, Naples 80131, Italy
ⁿ Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital

^∗Corresponding author. Department of Translational Medical Sciences, “Federico II” School of Medicine, “Federico II” University of Naples, Via Pansini 5, Naples 80131, Italy.Department of Translational Medical Sciences“Federico II” School of Medicine“Federico II” University of NaplesVia Pansini 5Naples80131Italy

Résumé

Acute pulmonary embolism (PE) is the third most common acute cardiovascular condition, and its prevalence increases over time. D-dimer has a very high negative predictive value, and if normal levels of D-dimer are detected, the diagnosis of PE is very unlikely. The final diagnosis should be confirmed by computed tomographic scan. However, echocardiography is the most available, bedside, low-cost, diagnostic procedure for patients with PE. Risk stratification is of utmost importance and is mainly based on hemodynamic status of the patient. Patients with PE and hemodynamic stability require further risk assessment, based on clinical symptoms, imaging, and circulating biomarkers.

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Keywords : Echocardiography, Biomarkers, Chronic thromboembolic pulmonary hypertension, Deep venous thrombosis, Pulmonary embolism, Thrombolysis, Venous thromboembolism

Plan

Key points

Introduction

Cardiac ultrasound and pulmonary embolism

Biomarkers in pulmonary embolism: is there something beyond D-dimer?

Biomarkers in the Right Context

Diagnosis of Pulmonary Embolism

Risk Stratification of Pulmonary Embolism

Risk stratification strategies in pulmonary embolism

Thrombolysis: to pulmonary embolism or not to pulmonary embolism?

Thrombolysis in Pulmonary Embolism

Chronic thromboembolic pulmonary hypertension screening after an acute pulmonary embolism

Summary

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Vol 16 - N° 3

P. 317-330 - juillet 2020 Retour au numéro

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