Clinics in chest medicine
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More aggressive therapy for acute pulmonary embolism beyond anticoagulation is indicated in patients at higher risk for mortality and morbidity, namely those suffering from massive and possibly submassive disease. Catheter-based thrombolysis, catheter-based mechanical thrombus debulking, or combinations of these offer opportunities for rapid clot reduction and clinical improvement with a lower bleeding risk than systemic thrombolysis and perhaps greater efficacy. Optimal low-dose regimens for direct thrombolysis have not been defined just as optimal techniques and devices for mechanical therapy have not been developed, underscoring the need for further work.
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Pulmonary embolism remains a leading cause of morbidity and mortality in the United States. However, with improved recognition and diagnosis, the risk of death diminishes. The diagnosis depends on the clinician's suspicion. ⋯ Imaging plus biomarkers help stratify patients according to risk. With the advent of the computed tomography multidetector scanners, the improved imaging has increased the detection of subsegmental and incidental pulmonary emboli. Treatment of low-risk as well as subsegmental and incidental pulmonary embolism is evolving.
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Clinics in chest medicine · Sep 2018
ReviewThe Value of Bedside Echocardiogram in the Setting of Acute and Chronic Pulmonary Embolism.
Echocardiography is valuable in the evaluation and risk stratification of patients with acute and chronic pulmonary embolism (PE). Patients with acute PE who have echocardiographic evidence of right ventricular dilatation and/or right ventricular dysfunction have a worse prognosis. A minority of patients with acute PE can develop chronic thromboembolic pulmonary hypertension. Patients with chronic thromboembolic pulmonary hypertension often have echocardiographic evidence of elevated pulmonary arterial pressures, right ventricular hypertrophy, right ventricular dysfunction, and/or left ventricular impaired relaxation.
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Clinics in chest medicine · Sep 2018
ReviewPulmonary Embolism Response Team: Inpatient Structure, Outpatient Follow-up, and Is It the Current Standard of Care?
Pulmonary Embolism Response Teams (PERTs) are being created around the United States to immediately and simultaneously bring together multiple specialists to determine the best course of action and coordinate clinical care for patients with severe pulmonary embolism (PE). The organization and structure of each PERT will depend on local clinical demands and resources. Creating a follow up clinic for PE patients after discharge from the hospital is an essential component of any PERT program. PERT programs, which have come together to form the PERT Consortium®, are changing the landscape of PE treatment and may represent a new standard of care.