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Cardiogenic shock
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
PE. Sinus tachycardia is the most common feature. There may be signs of right heart strain, such as right axis deviation or ST-segment changes in V1 and V2. The classically described SIQmTm is uncommon.
The heart, lungs and pleura
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
Pulmonary embolism is usually a complication of venous thromboembolic disease (see Chapter 10) (Revision panel 2.7). Less frequently, air, fat and amniotic fluid embolize to the lungs. Reduced pulmonary blood flow, local inflammation and right heart strain are responsible for the ensuing signs and symptoms.
Radiation-induced lung disease
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Max M Weder, M Patricia Rivera
Radiation exposure causes up-regulation of cytokines that play an important role in the development of pulmonary fibrosis.3 The induction of TGF-β has been studied most extensively. The level of TGF-β after radiation exposure has been used to predict the development of radiation-induced pulmonary fibrosis.4 Pro-inflammatory cytokines like TNF-α, IL-1 and fibrogenic IL-6 are up-regulated following radiation exposure. Platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) are potent stimulants of fibroblast proliferation and are also up-regulated following radiation exposure.5 may occur at rest in severe cases. In advanced stages, there may be signs of pulmonary hypertension and increased right heart strain.
Filler-induced non-thrombotic pulmonary embolism after genital aesthetic injection
Published in Journal of Cosmetic and Laser Therapy, 2022
The main clinical manifestations of FINTPE in these cases were respiratory disorders including dyspnea and chest pain. Typical pulmonary fat embolism induced by long bone fracture is usually manifested by hypoxemia, neurological abnormalities, or bruising rashes (20% to 50% of patients) that occur 24 to 72 hours after the initial injury (29,36). While in our study, almost 60% of FINTPE patients presented respiratory disorders within 12 hours post-operation. The onset of FINTPE clinical manifestations may vary depending on the size and material of the emboli and the body’s inflammatory response to them. Once many emboli directly enter the damaged blood vessel during the operation, it may cause the immediate type of FINTPE. In the cases of delayed FINTPE (over 24 hours), the inflammatory response may play a more critical role in the process than mechanical obstruction. Other frequently reported clinical manifestations include tachycardia, hypotension, right heart strain, fever, retinopathy, renal changes, and coagulopathy (29).
Nuts and bolts of COVID-19 associated coagulopathy: the essentials for management and treatment
Published in Postgraduate Medicine, 2021
Patrick J Lindsay, Rachel Rosovsky, Edward A Bittner, Marvin G. Chang
Currently, there are no diagnostic criteria for CAC. At present, there is no evidence or guideline to support routine screening for VTE, PE or other thrombotic complications in patients with COVID-19. However, the threshold to investigate for DVT or PE should be low given the frequency with which these complications may occur in patients with COVID-19. If thromboembolic disease is suspected, appropriate investigations should depend on the clinical context, acuity of disease and resources available. A position paper from the National Pulmonary Embolism Response Team (PERT) Consortium provides a step wise approach to a suspected PE, which includes ordering a computed tomography pulmonary angiogram (CTPA) if available [52]. If the computed tomography (CT) is not available or the patient is too unstable, a lower limb ultrasound to assess for a proximal DVT, or an echocardiography to assess right heart strain may be pursued. However, it should be noted that neither of these investigations are sensitive. If none of those modalities are available, nor do they rule in a PE/DVT, and there is a high clinical suspicion for a PE, therapeutic anticoagulation should be considered pending no absolute contraindications [52].
Application of the fourth universal definition of myocardial infarction in clinical practice
Published in Biomarkers, 2020
Johannes Mair, Louise Cullen, Evangelos Giannitsis, Ola Hammarsten, Kurt Huber, Allan Jaffe, Nicholas Mills, Martin Möckel, Christian Müller, Kristian Thygesen, Bertil Lindahl
Key clinical features that support the diagnosis:The initial clinical impression was based on typical chest pain and dynamic elevation of cardiac troponin, but there was no evidence of plaque rupture, erosion or intracoronary thrombus formation and CAG ruled out type 1 MI.No obvious alternative condition for causing oxygen supply-demand mismatch was identified on his initial assessment. Whilst the history with heavy physical exercise in cold air and stressful, dangerous conditions could trigger coronary vasospasm or a massive increase in blood pressure, there was no evidence to support either mechanism and type 2 MI was considered unlikely.When initial cardiac investigations do not clearly identify the mechanism of acute myocardial injury, further investigation is required. These investigations subsequently identified the cause of his symptoms to be a central pulmonary embolism, and that acute myocardial injury was a consequence of intermittent acute right heart strain.