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PULMONARY EMBOLISM – INFECTIOUS BLOOD DISEASE
A. S. Yadugiri, G.Aishwarya.
II B.E. (BiomedicalEngineering)
Dept. of Biomedical Engineering
Rajalakshmi Engineering College, Thandalam, Chennai – 602105
E-mail: [email protected]
[email protected]
ABSTRACT
The proposed paper discusses about the infectious
blood diseases named as pulmonary embolism. This
proposed paper mainly deals with increasing rate of
blood disease in the lungs. Pulmunoary Embolism is the
blockage in vein and due to circulation moves to the
main artery which goes from heart to lungs. This
paper fully discuses about the golden standard for
diagonsis pulmonary enbolism is pulmonary
angiography and treatment is caval filters. It is a deadly
infectious disesase. Pulmonary angiography is used less
often due to wider acceptance of CT scans, which are
non-invasive. The cavalfilters treatment the filters are
placed in inferior venacava below the orgin of renal
vessels. It occurs in 1% of patient admited in hospital
and resposible for 5% death of all hospital death. It may
occur due to amniotic fluid ,placenta,air , fat, tumour
and septic emboli from endo cardiatis affecting
tricuspid or pulmonary valve. The treatments are
anticouglation thromblitic threapy, caval filters..
KEY WORDS
Blockage in vein, Main artery, Pulmonary angiography,
Caval filters.
1. Introduction
Pulmunoary Embolism occurs silent. It is the blockage
in vein and due to circulation moves to the main artery
which goes from heart to lungs. Usually this is due to
embolism of a thrombus (blood clot) from the deep veins
in the legs, a process termed venous thromboembolism.
A small proportion is due to the embolization of air, fat ,
amniotic fluid placenta tumours and spectic emboli
from endo carditis affecting tricuspid or pulmonary
valve . The obstruction of the blood flow through the
lungs and the resultant pressure on the right ventricle of
the heart leads to the symptoms and signs of PE. The
risk of PE is increased in various situations, such as
cancer and prolonged bed rest.apparopriate therapy
and mortality is decreased from 30-10% yet 100,000200,000 death occur per year in USA.diagnosis of the
disease is very difficult. Clinical accuracy of the
diagnosis is low. It the prospective investigations of PE
study 755 patients had v/q lung scan and PE
Angiography because of suspected PE within 24hrs
study..
PULMONARY EMBOLISM
Pulmonary embolism can be usefully consider
under the heading venous thromboembolism 75%of
pulmonary embolism derived from DVT in the
lower limb and 60% of patient with DVT will have
evidence of PE on scanning even the absence of the
symptoms rarely PE may occur due to amniotic
fluid, placenta, air, fat, tumour and septic emboli
from endocarditis affecting tricuspid or pulmonary
valves. Pulmonary emboli occur in 1% of the
patients admitted in the hospital and are
responsible for 5% death.
He suggested 3 modes of death in PE
STUDIES RELATED TO PULMONARY
EMBOLISM:
One of the major studies related to PE is
PIOPED(Prospective investigation of pulmonary
embolism). Prior to the lung scan and PE Angiography,
PIOPED investigators estimated that chest x-ray , EKG,
and Arteial blood gas ananlysis. The results of PIOPED
makes it clear that clinical diagnosis for PE is inaccurate
Accuracy of clinical diagnosis of PE in the PIOPED thus
v/q lungs and PE angiography is done for diagnosis
Accuarcy in clinical diagnosis of PE in PIOPED study
CLINICAL
NO OF
PATIENTSS
PROBABILITY
80-100%
90
19-79%
569
0-19%
228



Sudden(instant within ten minutes)
Rapid (ten minutes to one hour)
Gradual (more than one hour)
HUMAN ET AL STUDIES
“ The mechanism of sudden death in coronary
pulmonale is unclear but it seems likely that
combination of factors are involved including
mechanical and humoral effects”
PERCENTAGEPERCENTAGE
HAVING PE
CONDITIONS ASSOCIATED IN PE
10
64
26
68
30
9

Surgery
1. orthopedic
2. gynaecological cancer
3. major abdnominal
4. coronary artery
5. by pass grafting
6. renal transplantation
7. splenectomy






Trauma
Immobilized medical patients
Cancer
Pregnancy/oral contraceptives
Obesity
Air travel
FRAMINGHAM STUDY :
His study in relation with heart indicated that
obesity among women is long time risk factor of PE. High
degree of ancient observation that of interruption of
pulmonary circulation paralyzes primarily the heart
rather than respiration in turn cardiac paralyses might
result from alteration of coronary blood flow. “PE is
caused sudden death due to the reduced blood flow to the
brain”.
BARDIN STUDY
He suggested that disorder under discussion might
result in the sudden death through a reflex arc
starting from pulmonary nerve endings,reaching
vagus sympathetic or phrenic nerve fibres, the
posterior cervical roots & from the respiratory &
cardiac centers.
LERICHE STUDY
In 1947 he concluded that immediate cause of
death by saying that “the patient with PE dies as well
from cardiac as from respiratory causes yet also dies
from cerebral causes
PILCHER STUDY
CLINICAL FEATURES OF PULMONARY
EMBOLISM
Acute massive pulmonary embolism
The clinical features are of acute heamondynamic
collapse with central chest pain, apprehension of
low cardiac output and syncope. The
phatophysiology is due to acute abstruction of more
than 50% of either the main or proximal pulmonary
artery, leading to an acute redction of cardiac
output and right ventricular dilation. On
examination there is a sinus tachycardiac ,
hypotention and peripheral vasoconstriction.
Tachypnonea is typically present cyanosis and
elevated JVP. A right ventricular gallop may be
heard with wide splitting of second heart sound.
Local signs.
Other signs of pulmonary hypotention are not
expected in acute massive pulmonary embolism.
Other
decreases urine output
Investigation
Chest radiography often subtile;oligamic lungs
Field ,slight increases hilar
Shadow
ECG
S 1Q3T3 T waves decreases
Acute massive PE
V1- V4 Right bundle-branch
Pathophysiology
major
Block.
heamodynamic effect
Decreases the
cardiac output;
Acute heart failure;
disorder
Blood gases
PaCO2
decreases PaO2;decreases
V/Q scan
prefusion.
major area of decreases
Pulmonary
definite diagonsis
Angiography
ventilation-prefusion
. ratio
Cardiac arrest in acute PE
Patients
Symptoms
sudden syncope,
faintness
Central chest pain,
Deceased
26
Survived
2
Total
28
apprehension
Sever dysponea.
Episode of cardiac arrest
Signs
Reversible
Cardiovascular
13
major circulatory collapse;
Due to electromechanical dissociation
12
Due to asystole
01
Tachycardiac; hypotention;
Increases jugular venous
pressure
Irreversible
Gallop rhythm; P2 widely
Due to electromechanical dissociation
22
Due to asystole
3
Due to ventricular filling after
1
split.
Respiratory
severe cyanosis, otherwise no
Atrio ventricular block
Total
39
Blood gases
decreases PaCO2
V/Q scan
on
prefision defect not matched
Acute minor pulmonary embolism
The majority of patients will present with so called
pulmonary infraction syndrome with pluerisy
shortness of breath and haemoptysis. Clinically
there may be plueral rubs and sign of a plueral
effusion. The chest radiography may show wedge
shaped opacity due to heamorrhages, pleural
effusion or an elevated diaphragm. Some cases
present with isolated breathlessness and these
patients tend to have more effective central
thrombus if pulmonary angiography is performed.
Acute small/medium PE
Pathophysiology
occulusion of segmental
Pulmonary artery-infraction
+_effusion.
the ventilation scan.
Pulmonary
definite diagonsis
Angiography
Acute embolism in patients with chronic
cardio pulmonary disease
Patients with a small degree of cardiopulmonary
reserve may demonstrate a major sudden
deterioration in their clinical state even with small
pulmonary emboli. The clinical features of PE may
be obscured by clinical feature of the underlying
diseases and diagosis can be difficult in this
important situation. A high index of suspicion is
required if successful investigation and
management in this group of patient are to be
achived.
Chronic pulmonary embolism leading to
thromboembolic pulmonary hypertention.
Symptoms
pluerisy, restied
breathing,
heamophysis
.
Signs
Cardiovascular
tachycardia.
Respiratory
pleural rub raised
Hemidiaphragm, crepiations
effusion
Other
low grade fever
This is a relatively rare but important condition
which arises without a history of prevous acute PE
in over 50% of cases. Patient typicaly present with
a history of exertional breathlessness, syncope and
chest pain developing over a months or years. On
examinationther are signs of pulmonary
hypertention with a loud pulmonary components to
second heart sound and a right ventricular heaves.
The JVP is raised and there may be v waves
indicating tricuspid reguration. Patient with a
pulmonary hypertention secondary to chronic
pulmonary emboli should be considered for
thromboendarterectomy an operation that involves
removal of organised obstucting thrombus via an
endarterectomy. The operation should be caried out
with specalit centers despite a significant oprative
mortality ,it has a high degree of success.
Acute massive PE
Pathophysiology
Investigation
Chest radiography pleuropulmonary opacities;
Microvasculature, pulmonary
Pleural effusion; linear
shadow;
Hypertention ,right heart
falure.
Raised hemidiaphragm
ECG
cornic occulision of
pulmonary
sinus tachycardia
Symptoms
RV
exertional dysponea, late-
Exertional syncope symptoms
And RV faliure.
Signs
Cardiovascular
disease late
may be minimal early
-RV heave ,loud split P2
Terminal
-sign of RV faliure.
Investigation
Chest radiography
enlarged pulmonary artery trunk
Symptoms of PE are sudden-onset dyspnea (shortness of
breath), tachypnea (rapid breathing), chest pain of a
"pleuritic" nature (worsened by breathing), cough and
hemoptysis (coughing up blood). More severe cases can
include signs such as cyanosis (blue discoloration,
usually of the lips and fingers), collapse, and
circulatory instability. About 15% of all cases of sudden
death are attributable to PE.
On physical examination, a pleural rub may be audible
by stethoscope over affected areas of the lung. Strain on
the right ventricle may be detected as a left parasternal
heave, a loud pulmonary component of the second heart
sound, raised jugular venous pressure, and more rarely
leg swelling.
The major symptoms/ most frequent symptoms are
dyspnea and pleuritic chest pain. Incidence of pleuritic
pain and dyspnea in patients with angiographically
documented PE
Enlarged heart, prominent RV.
ECG
signs of RV hypertropy and strain
Blood gases
exertional decrease PaO2 or
STUDY
NO OF
PATIENTS
Bell.et al
Dalen
PIOPED
327
124
117
desaturation
V/Q scan
may be non abnormality.
Pulmonary
usually diagnotic; may need
Angiography
lung biopsy to confirm the
Diagnosis
Symptoms of pulmonary embolism
include





difficulty breathing,
chest pain on inspiration, and palpitations.
Clinical signs include low blood oxygen
saturation and cyanosis,
rapid breathing, and a rapid heart rate.
Severe cases of PE can lead to
1. collapse,
2. abnormally low blood pressure, and
3. sudden death.
Diagnosis is based on these clinical findings in
combination with laboratory tests (such as the D-dimer
test) and imaging studies, usually CT pulmonary
angiography. Treatment is typically with anticoagulant
medication, including heparin and warfarin. Severe
cases may require thrombolysis with drugs such as
tissue plasminogen activator (tPA) or may require
surgical intervention via pulmonary thrombectomy.
% WITH
PLEURITIC
PAIN
74
57
66
% WITH
DYPSNEA
84
77
73
Diagnosis
The diagnosis of PE is based primarily on validated
clinical criteria combined with selective testing because
the typical clinical presentation (shortness of breath,
chest pain) cannot be definitively differentiated from
other causes of chest pain and shortness of breath. The
decision to do medical imaging is usually based on
clinical grounds, i.e. the medical history, symptoms and
findings on physical examination, followed by an
assessment of clinical probability.
The most commonly used method to predict clinical
probability, the Wells score, is a clinical prediction
rule, whose use is complicated by multiple versions
being available. In 1995, Wells et al. initially developed
a prediction rule (based on a literature search) to
predict the likelihood of PE, based on clinical criteria.
The prediction rule was revised in 1998 This prediction
rule was further revised when simplified during a
validation by Wells et al. in 2000. In the 2000
publication, Wells proposed two different scoring
systems using cutoffs of 2 or 4 with the same prediction
rule. In 2001, Wells published results using the more
conservative cutoff of 2 to create three categories. An
additional version, the "modified extended version",
using the more recent cutoff of 2 but including findings
from Wells's initial studies were proposed. Most
recently, a further study reverted to Wells's earlier use
of a cutoff of 4 points to create only two categories.
There are additional prediction rules for PE, such as
the Geneva rule. More importantly, the use of any rule
is associated with reduction in recurrent
thromboembolism.
The Wells score







clinically suspected DVT - 3.0 points
alternative diagnosis is less likely than PE 3.0 points
tachycardia - 1.5 points
immobilization/surgery in previous four weeks
- 1.5 points
history of DVT or PE - 1.5 points
hemoptysis - 1.0 points
malignancy (treatment for within 6 months,
palliative) - 1.0 points
Traditional interpretation



Score >6.0 - High (probability 59% based on
pooled datal)
Score 2.0 to 6.0 - Moderate (probability 29%
based on pooled data)
Score <2.0 - Low (probability 15% based on
pooled datal)
Alternate interpretation

Score > 4 - PE likely. Consider diagnostic
imaging.
Score 4 or less - PE unlikely. Consider D-dimer to rule
out PE
Pulmonary angiography
A pulmonary angiography is is a procedure that uses a
special dye (contrast material) and x-rays to see how
blood flows through the lungs.
How the Test is Performed
This test is done in a hospital. You will be asked to lie
on an x-ray table. Electrocardiogram (ECG) leads are
taped to your arms and legs to monitor the electrical
impulses of the heart.
Before the test starts, you will be given a mild sedative
to help you relax.
An area of your body, usually the arm or groin, is
cleaned and numbed with a local numbing medicine
(anesthetic). The radiologist makes a small surgical cut
in an artery in the area that has been cleaned, and
inserts a thin hollow tube called a catheter. The
catheter is placed through the artery and carefully
moved up into and through the heart chambers and into
the pulmonary artery, which leads to the lungs.
The doctor can see live x-ray images of the area on a
TV-like monitor, and uses them as a guide.
Once the catheter is in place, dye (contrast material) is
injected into catheter. X-ray images are taken to see
how the dye moves through the lung arteries. The dye
helps highlight any blockages in blood flow.
The catheter is occasionally flushed with saline solution
containing a drug called heparin to help keep blood in
the tube from clotting.
Your pulse, blood pressure, and breathing are
monitored during the procedure.
After the x-rays are taken, the needle and catheter are
withdrawn.
Pressure is immediately applied to the puncture site for
10-15 minutes to stop the bleeding. After that time the
area is checked and a tight bandage is applied. The leg
should be kept straight for 12 hours after the procedure.
The x-ray will show normal structures for the age of the
patient.
What Abnormal Results Mean
Abnormal results may be due to:





Blood clot in the lungs
Narrowed blood vessel
Primary pulmonary hypertension
Pulmonary embolism
Tumor
Risks
How to Prepare for the Test
You should not eat or drink anything for 4 - 8 hours
before the test.
You will be asked to wear a hospital gown and sign a
consent form for the procedure. Jewelry should be
removed from the area being imaged.
Tell your health care provider:





If you are pregnant
If you have ever had any allergic reactions to
x-ray contrast material or iodine substances
If you are allergic to any medications
Which medications you are taking (including
any herbal preparations)
If you have ever had any bleeding problems
How the Test Will Feel
The x-ray table is hard and cold, but you may ask for a
blanket or pillow. You may feel a brief sting when the
numbing medicine is given and a brief, sharp, stick as
the catheter is inserted.
You may feel some pressure as the catheter moves up
into the lungs. The contrast dye can cause a feeling of
warmth and flushing. This is normal and usually goes
away in a few seconds.
Occasionally abnormal cardiac rhythm can develop
during the procedure. The doctors will monitor your
heart and can treat any abnormal rhythms that develop.
Other risks include:




Allergic reaction to the contrast dye
Blood vessel damage
Blood clot traveling to the lungs, causing an
embolism
Excessive bleeding or blood clot, which can
reduce blood flow to the leg
There is low radiation exposure. X-rays are monitored
and regulated to provide the minimum amount of
radiation exposure needed to produce the image. Most
experts feel that the risk is low compared with the
benefits.
Pregnant women and children are more sensitive to the
risks of x-rays.
COMPUTED TOMOGRAPHY
Pulmonary angiography (or pulmonary arteriography)
is a cardiological medical procedure. Pulmonary blood
vessels are x-rayed to detect arteriovenous
malformations.
Why the Test is Performed
Direct angiography is the injection of radiocontrast into
the circulation with subsequent fluoroscopy (direct Xray visualisation) of the lungs. A more common form of
direct angiography, is the catheterisation of the right
atrium of the heart and injection of radiocontrast into
the right heart.
The test is used to detect blood clots and other
blockages in the blood flow in the lung (pulmonary
embolism).
A popular form of pulmonary angiography is computed
tomography pulmonary angiography (CTPA). This
involves venous contrast only.
Normal Results
Invasive pulmonary angiography was first performed in
1931 by Egas Moniz and colleagues.[1] Robb and
You may have some tenderness and bruising at the site
of the injection after the test.
Steinberg described pulmonary angiography by infusion
of peripheral radiocontrast.[2][3]
CTPA was introduced in the 1990s as an alternative to
ventilation/perfusion scanning, which relies on
radionuclide imaging of the blood vessels of the lung. It
is regarded as a highly sensitive and specific test for
pulmonary embolism.[1]
Interpretation
On CTPA, the pulmonary vessels are filled with
contrast, and appear white. Any mass filling defects
(embolus or other matter such as fat or amniotic fluid)
appears darker. Generally, the scan should be complete
before the contrast reaches the left side of the heart and
the aorta, which could result in artifacts.
CTPA is typically only requested if pulmonary embolism
is suspected clinically. If the probability of PE is
considered low, a blood test called D-dimer may be
requested. If this is negative, risk of a PE is considered
negligible and CTPA or other scans are generally not
performed. Most patients will have undergone a chest
X-ray before CTPA is requested
After initial concern that CTPA would miss smaller
emboli, a 2007 study comparing CTPA directly with
ventilation/perfusion scanning found that CTPA
identified more emboli without decreasing the risk of
long-term complications compared to V/Q scanning
Contraindications
CTPA is generally avoided in pregnancy due to the
amount of ionizing radiation required, which may
damage the fetus
CTPA is contraindicated in known or suspected allergy
to contrast media or in renal failure (where contrast
agents could worsen the renal function)
Acquisition
The best results are obtained using multidetector
computed tomography (MDCT) scanners
An intravenous cannula is required for the
administration of the 50-150 ml. of radiocontrast. This
is injected, usually automatically, by a syringe driver, at
a rate of 4 ml./second. Many hospitals use bolus
tracking, where the scan commences when the contrast
is detected at the level of the proximal pulmonary
arteries. If this is done manually, scanning commences
about 10–12 seconds after the injection has started.
Slices of 1-3 mm. are performed at 1-3 mm. intervals,
depending on the nature of the scanner (single- versus
multidetector)
State of the art CT machines can complete a scan in
approximately five seconds and it is possible to
complete the entire procedure (set-up, injection and
scanning) in the space of five minutes.
What is CT angiography?
Angiography is a minimally invasive medical test that
helps physicians diagnose and treat medical conditions.
Angiography uses one of three imaging technologies
and, in some cases, a contrast material to produce
pictures of major blood vessels throughout the body.
Angiography is performed using:
 x-rays with catheters
 computed tomography (CT)
 magnetic resonance imaging (MRI)
CT imaging uses special x-ray equipment to produce
multiple images and a computer to join them together in
multidimensional views. In CT angiography (CTA),
computed tomography using a contrast material
produces detailed images of both blood vessels and
tissues.
What are the benefits vs. risks?

If you have a history of allergy to x-ray
contrast material, your radiologist may advise
that you take special medication for 24 hours
before CT angiography to lessen the risk of
allergic reaction. Another option is to undergo
a different exam that does not call for contrast
material injection.

If a large amount of x-ray contrast material
leaks out from the vessel being injected and
spreads under the skin where the IV is placed,
skin damage or damage to blood vessels and
nerves, though unlikely, can result. If you feel
any pain in this area during contrast material
injection, you should immediately inform the
technologist.

Women should always inform their physician
and x-ray or CT technologist if there is any
possibility that they are pregnant

Nursing mothers should wait for 24 hours after
contrast material injection before resuming
breast-feeding.

The risk of serious allergic reaction to contrast
materials that contain iodine is extremely rare,
and radiology departments are well-equipped
to deal with them.
Benefits


Angiography may eliminate the need for
surgery. If surgery remains necessary, it can
be performed more accurately.
CT angiography is able to detect narrowing of
blood vessels in time for corrective therapy to
be done.

CT angiography gives more precise
anatomical detail of blood vessels than
magnetic resonance imaging (MRI).

Many patients can undergo CT angiography
instead of a conventional catheter angiogram.

Compared to catheter angiography, which
involves placing a catheter (plastic tube) and
injecting contrast material into a large artery
or vein, CT angiography is a much less
invasive and more patient-friendly procedure.

This procedure is a useful way of screening for
arterial disease because it is safer and much
less time-consuming than catheter angiography
and is a cost-effective procedure. There is also
less discomfort because contrast material is
injected into an arm vein rather than into a
large artery in the groin.

No radiation remains in a patient's body after
a CT examination.

X-rays used in CT scans usually have no side
effects.
Risks

There is always a slight chance of cancer from
excessive exposure to radiation. However, the
benefit of an accurate diagnosis far outweighs
the risk.
What are the limitations of CT Angiography?
A person who is very large may not fit into the opening
of a conventional CT scanner or may be over the weight
limit for the moving table.
CT angiography should be avoided in patients with
advanced kidney disease or severe diabetes, because xray contrast material can further harm kidney function.
If a patient's heart is not functioning normally, or if
there are multiple blocked blood vessels, CT
angiograms may be hard to interpret. CT angiograms
are not yet as reliable as selective catheter injections
(performed after puncture of the artery in the groin) in
imaging small tortuous arteries, particularly coronary
arteries in the rapidly moving heart.
TRAETMENTS INVOLVED IN
PULMONARY EMBOLISM
CAVAL FILTERS
An inferior vena cava filter, also IVC filter a type of
vascular filter, is a medical device that is implanted into
the inferior vena cava to prevent fatal pulmonary
emboli (PEs).
Inferior vena cava filter - Gunther Tulip
IVC filters are used in case of contraindication to
anticoagulation, failure of anticoagulation or
complication to anticoagulation in patients who have a
venous thromboembolic disease or in prophylactic use
for patients with a high risk of pulmonary embolism.
Placement
IVC filters are placed endovascularly, meaning that
they are inserted via the blood vessels. Historically, IVC
filters were placed surgically, but as designs changed
they could be placed via the groin through a thin tube
or catheter. With modern filters which can be
compressed into much thinner catheters, however,
access to the venous system can be obtained either via
the femoral vein (the large vein in the groin),the
internal jugular vein (the large vein in the neck.) or via
the arm veins with one design. Choice of route depends
mainly on the amount and location of blood clot within
the venous system. To place the filter, a catheter is
guided into the IVC using fluoroscopic guidance, then
the filter is pushed through the catheter and deployed
into the desired location, usually just below the junction
of the IVC and the lowest renal vein.
Review of prior cross-sectional imaging or a venogram
of the IVC is performed before deploying the filter to
assess for potential anatomic variations, thrombi within
the IVC, or areas of stenoses, as well as to estimate the
diameter of the IVC. Rarely, ultrasound-guided
placement is preferred in the setting of contrast allergy,
renal insufficiency, and when patient immobility is
desired. The size of the IVC may affect which filter is
deployed, as some (such as the Birds Nest) are
approved to accommodate larger cavas. There are
situations where the filter is placed above the renal
veins (e.g. pregnant patients or women of childbearing
age, renal or gonadal vein thromboses, etc.). Also, if
there is duplication of the IVC, the filter is placed above
the confluence of the two IVCs or a filter can be placed
within each IVC.
Indications for use
Most filters are placed for the following reasons.




Failure of anticoagulation; eg development of
deep vein thrombosis (DVT) or pulmonary
emboli (PE) despite adequate anticoagulation.
Contraindications to anticoagulation; eg a
patient at risk of PE who has another condition
that puts them at risk of bleeding, such as a
recent bleed into the brain, or a patient about
to undergo major surgery
Large clots in the vena cava or iliac veins
Patients at high risk of having a PE
DEATH RATE IN PE
9
8
death rate white
men
7
6
death rate white
women
5
death rate non
white men
4
3
Retrieval
Most IVC filters are permanent, but some filters are
now available that are "retrievable." Retrievable filters
are fitted with some sort of device (that varies from
model to model) that allows them to be pulled back into
a catheter (technically a "sheath") and removed from
the body, often through the Jugular vein. Previously,
filters that had been in the IVC for less than three weeks
were considered suitable to attempt retrieval, as filters
that have been in place longer might have been
overgrown by cells from the IVC wall and there was an
increased risk of IVC injury if the filter is dislodged.
Newer designs, and developments in techniques mean
that some filters can now be left in for prolonged
periods and retrievals after a year are now being
reported. This would include the ALN, Option, Tulip
and Celect filters.
death rate non
white women
2
1
0
1962- 1965- 1970- 1975- 198064
69
74
79
84
Localization of PE in subject who were the victim of
sudden unexpected death
AREA
TOTAL
PERCENTAGE
Major pulmonary
8
16.1
artery
Right and left
10
20.4
branches
Right branch
7
14.2
Left branch
2
4.1
Lobar and
7
14.2
segmental
artery(unilateral)
Lobar and
5
10.2
segmental
artey(bilateral)
Sub-segmental
artery(unilateral)
Sub-segmental
artey(bilateral)
3
6.1
7
14.2
PROGNOSIS:
The prognosis of acute PE depends on several
factors among the most of the important presence of
concomitant disease especially malignancy previous
cardiac or PE disease, patients age, size, localization,
age of PE, degree of pulmonary hypertension. Acute PE
reflected by degree of pulmonary hypertension &
presence of pulmonary(or) cardiac disease.
CONCLUSION:
Thus the pulmonary embolism is considered as a
deadly infectious disease which leads to death
immediately. Thus immediate diagnosis& treatment for
the various symptoms of PE has been discussed
thoroughly in this paper.
ACKNOWLEDGEMENTS
The authors wish to thank the Chairperson and
Principal, for all the facilities provided and all the staff
members of the department of Biomedical Engineering
who have rendered their support, guidance and
encouragement to us in the making of this paper.
REFERENCES:
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Book on pulmonary embolism by M.Morpugo
Book on current diagnosis and treatment in
cardiology by Michael.H.Crawford
Book on principles of medicine by Davidson
Harrisons text book of medicine
Golwalla text book of medicine
Pulmonary embolism by Paul.D. stein