Tỷ lệ thuyên tắc động mạch phổi ở bệnh nhân nội trú tại viện tim mạch việt nam trong năm 2016

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 PE: Background - Epidemiology - Risk factors - Pathophysiology - Diagnosis Our study: - Object - Method - Results - Conclusion BACKGOUND Epidemiology - 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 7% 34% 59% death resulting from PE and undiagnosed during life presented with sudden fatal death correcly diagnosed during life (2014 ESC Guidelines) 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 Age distribution Mean 57 ± 18,26 yrs Max 86 Min 27 Female RISK FACTORS 10% Within weeks after surgery Cerebral infraction BMI>24 Hypercholesterolaemia unknown 15% 55% 15% 5% CLINICAL PREDICTION RULE for PE WELL rule GENEVA score 11 12 High probability Moderate probability Low probability CLINICAL SIGNS 13 0.75 10 0.5 0.25 SHOCK SYNCOPE HEART BEAT >100 DYSPNOEA CHEST PAIN FEVER HEMOPTYSIS - ARTERIAL BLOOD GAS Present Absence pH > 7,45 46% 54% pO2 < 80 mmHg 77% 23% pCO2 2mmol/L 38% 62% - D-dimer increase in 100% cases - Doppler ultrasound of the lower limbs: presented in 50% patients Echocardiograms PH 0.25 0.5 20-50 mmHg 0.75 >50 mmHg RV dilation 0.25 =20 mm COMPUTED TOMOGRAPHIC PULMONARY ANGIOGRAPHY: (CT) image of thrombosis in 100% patients - ARTERIAL BLOOD GAS Present Absence pH > 7,45 46% 54% pO2 < 80 mmHg 77% 23% pCO2 2mmol/L 38% 62% - D-dimer increase in 100% cases - Doppler ultrasound of the lower limbs: presented in 50% patients 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 ... 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... contraceptive - Hormone replacement therapy - Cancer - Infection - Blood transfusion/Erythropoiesis-stimulating agents Pathophysiology DIAGNOSIS STRATEGY OBJECT OBSERVE & DESCRIBE CLINICAL FEATURES