Index
What does it consist of?
There are different ways of experiencing what it is to be close to death. Thromboembolism is one of those diseases that, on hatching, place the person in a thin line between life and death.
The first thing you should know is that it encompasses two interrelated conditions that are part of the same spectrum, deep vein thrombosis (DVT) and pulmonary embolism (PE).
The spectrum of the disease is broad. And is that this disease can range from clinically unsuspected to clinically unimportant, even to the massive embolism causing death.
Signs and symptoms
The signs and symptoms of thromboembolism include the following:
- Acute appearance of shortness of breath; dyspnea is the most common symptom of PE
- Pleuritic chest pain, cough, or hemoptysis (with a smaller PE near the pleura)
- Syncope (with a massive EP)
- Sense of imminent death, with apprehension and anxiety
- Complaints related to signs of DVT, swelling of lower extremities, and warmth to touch or sensitivity
- Tachypnea (respiratory rate> 18 breaths / min)
- Tachycardia
- Second accented sound of the heart
- Fever
- Abnormal findings of lung examination
- Cyanosis
About the Diagnosis
The most used methods include:
- Pulmonary angiography: standard diagnosis for PE.
- Ventilation-perfusion scan: The most common detection technique.
- Venography: Standard test to validate new diagnostic procedures.
- Values of arterial gasometry in ambient air: hypoxemia, elevated alveolar-arterial oxygen gradient.
- Acid-base status: Respiratory alkalosis.
- Immunoenzymatic assay (ELISA) for D-dimer.
- Electrocardiography, especially to rule out myocardial infarction.
- Chest x-ray: most of the time it is normal but occasionally suggestive.
- Helical computed tomography (spiral) of the pulmonary vessels.
- Doppler ultrasound of the venous system.
- Echocardiography
- Impedance plethysmography: Of limited value when DVT is asymptomatic or distal or when the findings are non-occlusive.
History
With pulmonary embolism (PE) the patient often experiences an acute onset of shortness of breath; Sometimes the patient even points and indicates the moment of anguish.
Complaints related to signs of deep vein thrombosis (DVT), swelling of the lower extremities and warmth to the touch or sensitivity may be present. Dyspnea is the most frequent symptom of PD.
With an EP of less impact near the pleura, the patient may complain of pleuritic chest pain, cough, or hemoptysis.
Sometimes, the massive EP may present with syncope. The patient may have a sense of imminent death, with apprehension and anxiety. History can reveal the presence of one or more causes or risk factors.
Physical exam
Some patients have signs of DVT, swelling in the lower limbs, sensitivity and warmth to the touch. The clinical signs of pulmonary thromboembolism also include the following:
- The tachypnea (greater than 18 breaths / min respiratory rate) is the most common sign of EP
- Tachycardia is often present.
- The second heart sound can be accentuated.
- The fever may be present.
- The findings of the lung examination are often normal.
- The cyanosis may be present.
In the appropriate clinical context, when there is difficulty in breathing, hypoxemia and tachycardia, there should be a high clinical suspicion of PD until it is ruled out. Timely anticoagulation is important; 5-7% of recurrences are fatal.
The probability of PE in a patient in whom it is suspected can be evaluated by the Wells clinical decision rule. The criteria are qualified as follows:
- Clinical symptoms of DVT (3 points)
- Other diagnoses less likely than PE (3 points)
- Heart rate greater than 100 beats / min (1.5 points)
- Immobilization for at least 3 days or surgery in the previous 4 weeks (1.5 points)
- Previous DVT / PE (1.5 puntos)
- Hemoptisis (1 punto)
- Malignancy (1 point)
In modified Wells criteria, PE is likely when the score is higher than 4 and unlikely when the score is less than 4. Highly sensitive D-dimer is coupled in the decision algorithm.
What are the warning signs?
The TVP mainly affects the large veins in the lower leg and thigh, usually on one side of the body at once. The clot can block blood flow and cause:
- Pain in the legs or sensation in the thigh or calf.
- Swelling of the legs (edema).
- Skin that feels warm to the touch.
- Reddish discoloration or red streaks.
- PE, or pulmonary embolism, can be fatal and occurs when DVT is released from a venous wall and blocks part or all of the blood supply to the lungs, causing:
- Unexplained shortness of breath
- Fast breathing
- Chest pain anywhere under the rib cage (may be worse with deep breathing)
- Rapid heart rate
- Dizziness or fainting
The Epidemiology of Venous Thromboembolism according to the ethnic community
Venous thromboembolism is a major health problem. The average annual incidence of venous thromboembolism among whites is 108 per 100 000 person-years, 1.2 with around 250 000 incident cases occurring annually among American whites.
The incidence appears to be similar or higher among blacks and lower among Asians and natives.
Adjusting the distribution by age and sex of African Americans, the incidence of venous thromboembolism is around 78 per 100,000, suggesting that approximately 27,000 cases of incident venous thromboembolism occur annually among black Americans.
Recent models suggest that more than 900,000 incident or recurrent, fatal and non-fatal VTE events occur annually in the United States.
The incidence of venous thromboembolism has not changed significantly during the past 25 years.2
Age factor
Venous thromboembolism is predominantly an older disease.
Incidence rates increase exponentially with age, both for men and women, both for deep vein thrombosis and for pulmonary embolism.
The overall incidence rate adjusted for age is higher for men (114 per 100 000), women (105 per 100 000, males: female is 1.2: 1).
The incidence rates are somewhat higher in women during the years of fertility, while incidence rates after 45 years are generally higher in men.
Pulmonary embolism explains an increasing proportion of venous thromboembolism with increasing age for both genders.
