Clinical features of in-patients at Vietnam national heart institute - Phạm Minh Tuấn

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 
- 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 
59% 
34% 
7% 
death resulting from PE and undiagnosed during life
presented with sudden fatal death
correcly diagnosed during life (2014 ESC Guidelines) 
Epidemiology 
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 Female
Mean 57 ± 18,26 yrs 
Max 86 
Min 27 
Age distribution 
10% 
15% 
15% 
5% 
55% 
Within 4 weeks after surgery
Cerebral infraction
BMI>24
Hypercholesterolaemia
unknown
RISK FACTORS 
1 
1 
11 
12 
2 
1 
WELL rule
GENEVA score
High probability Moderate probability Low probability
CLINICAL PREDICTION RULE for PE 
CLINICAL SIGNS 
1 
2 
10 
13 
8 
4 
1 0
0.25
0.5
0.75
1
SHOCK SYNCOPE HEART BEAT >100 DYSPNOEA CHEST PAIN FEVER HEMOPTYSIS
- ARTERIAL BLOOD GAS 
- D-dimer increase in 100% cases 
- Doppler ultrasound of the lower limbs: presented in 50% patients 
Present Absence 
pH > 7,45 46% 54% 
pO2 < 80 mmHg 77% 23% 
pCO2 <35 mmHg 62% 38% 
Lactate > 2mmol/L 38% 62% 
Echocardiograms 
0 0.25 0.5 0.75 1
PH
20-50 mmHg >50 mmHg
0 0.25 0.5 0.75 1
RV dilation
=20 mm
COMPUTED TOMOGRAPHIC PULMONARY ANGIOGRAPHY: (CT) 
image of thrombosis in 100% patients 
- ARTERIAL BLOOD GAS 
- D-dimer increase in 100% cases 
- Doppler ultrasound of the lower limbs: presented in 50% patients 
Present Absence 
pH > 7,45 46% 54% 
pO2 < 80 mmHg 77% 23% 
pCO2 <35 mmHg 62% 38% 
Lactate > 2mmol/L 38% 62% 
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