1 / 30

Disciplina TIC5007 Emergências Cardiovasculares Discussão de Caso Aluno: Rodrigo J Ramalho

Disciplina TIC5007 Emergências Cardiovasculares Discussão de Caso Aluno: Rodrigo J Ramalho. What are the causes of recurrent pulmonary embolism? In patients with recurrent pulmonary embolism it is important to try to establish a cause: Factor V Leiden mutation

leo-sloan
Télécharger la présentation

Disciplina TIC5007 Emergências Cardiovasculares Discussão de Caso Aluno: Rodrigo J Ramalho

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Disciplina TIC5007 Emergências Cardiovasculares Discussão de Caso Aluno: Rodrigo J Ramalho

  2. What are the causes of recurrent pulmonary embolism? In patients with recurrent pulmonary embolism it is important to try to establish a cause: Factor V Leiden mutation Activated protein C resistance Inherited deficiencies of antithrombin III Protein C or S deficiency Lupus anticoagulant Behçet’s disease Nephrotic syndromew1 What syndrome is being described in the medical history? The man has nephrotic syndrome, a triad of proteinuria (>3 g/day), hypoalbuminaemia (<30 g/l), and oedema. Nephrotic syndrome is also associated with hyperlipidaemia and thrombotic disease. The function of the glomerular basement membrane is altered, resulting in urinary loss of protein, know as proteinuria. When in the nephrotic range, as for this man, this leads to hypoalbuminaemia (box 1). He represents the 5.5% of children with minimal change nephrotic syndrome relapse into adulthood.w6 With treatment he is no longer hypoalbuminaemic, protein is not detectable on dipsticks, and his oedema is resolving. He has been advised to monitor his urine for protein. He confessed to not having been vigilant about this. He may benefit from some education; with a better understanding of the implications of proteinuria he may improve his monitoring.

  3. Epidemiologia Meyer G e col, BMJ 2010;340:c1421

  4. A triade clássica de dor pleuritica, dispnéia e hemoptise ocorre em menos de 10% dos pacientes. Síncope é um sinal esquecido de manifestação de TEP, mas pode estar presente em até 13% dos pacientes à admissão. A incidência de síncope é de 24% em pacientes acima de 65 anos, comparado com apenas 3% nos menores de 65 anos.

  5. Fatores de risco para TVP/TEP Em 40% dos casos os principais fatores de risco estão ausentes. Sinais de TVP são observados em menos de 15% dos pacientes. Meyer G e col, BMJ 2010;340:c1421 Tapson VF, N Engl J Med 2008; 358:1037-52

  6. Fatores de risco para TVP/TEP em pacientes internados Francis CW, N Engl J Med 2007; 356:1438-44

  7. Avaliação da probabilidade pré-teste Meyer G e col, BMJ 2010;340:c1421

  8. Prevalência de EP de acordo com a probabilidade pré-teste

  9. Exames Complementares RX tórax ECG ECO

  10. Exames Complementares RX tórax: atelectasias laminares derrame pleural, e elevação de cúpula diafragmática achados clássicos – raros - amputação de artéria pulmonar - oligemia - infiltrado em forma de cunha ECG ECO

  11. ECG

  12. Exames Complementares ECO: sinais indiretos: disfunção ventrículo direito; gradiente de pressão sistólica entre atrio e ventriculo direito > 30 mmHg; tempo de aceleração de fluxo arterial pulmonar menor que 80 msec; forame oval patente; trombo livre e flutuante em atrio direito; hipertensão pulmonar persistente.

  13. Algoritmo Diagnóstico Tapson VF, N Engl J Med 2008; 358:1037-52

  14. Konstantinides S, N Engl J Med 2008; 359:2804-13

  15. Konstantinides S, N Engl J Med 2008; 359:2804-13

  16. Tratamento Tapson VF, N Engl J Med 2008; 358:1037-52

  17. Tratamento Tapson VF, N Engl J Med 2008; 358:1037-52

  18. Tratamento Indications : Absolute contraindication to anticoagulation (eg, active bleeding) Recurrent PE despite adequate anticoagulant therapy Complication of anticoagulation (eg, severe bleeding) Hemodynamic or respiratory compromise that is severe enough that another PE may be lethal Tapson VF, N Engl J Med 2008; 358:1037-52

  19. Tratamento Tapson VF, N Engl J Med 2008; 358:1037-52

  20. Algoritmo para pacientes com hipotensão ou choque Konstantinides S, N Engl J Med 2008; 359:2804-13

  21. Konstantinides S, N Engl J Med 2008; 359:2804-13

  22. Konstantinides S, N Engl J Med 2008; 359:2804-13

More Related