Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary Embolism
Acute pulmonary embolism (PE) can be devastating. It is classified into three categories based on clinical scenario, elevated biomarkers, radiographic or echocardiographic features of right ventricular strain, and hemodynamic instability. Submassive PE is diagnosed when a patient has elevated biomar...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/297951 |
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| author | Sachin Kumar Amruthlal Jain Brijesh Patel Wadie David Ayad Jazrawi Patrick Alexander |
| author_facet | Sachin Kumar Amruthlal Jain Brijesh Patel Wadie David Ayad Jazrawi Patrick Alexander |
| author_sort | Sachin Kumar Amruthlal Jain |
| collection | DOAJ |
| description | Acute pulmonary embolism (PE) can be devastating. It is classified into three categories based on clinical scenario, elevated biomarkers, radiographic or echocardiographic features of right ventricular strain, and hemodynamic instability. Submassive PE is diagnosed when a patient has elevated biomarkers, CT-scan, or echocardiogram showing right ventricular strain and no signs of hemodynamic compromise. Thromboemboli in the acute setting increase pulmonary vascular resistance by obstruction and vasoconstriction, resulting in pulmonary hypertension. This, further, deteriorates symptoms and hemodynamic status. Studies have shown that elevated biomarkers and right ventricular (RV) dysfunction have been associated with increased risk of mortality. Therefore, aggressive treatment is necessary to “unload” right ventricle. The treatment of submassive PE with thrombolysis is controversial, though recent data have favored thrombolysis over conventional anticoagulants in acute setting. The most feared complication of systemic thrombolysis is intracranial or major bleeding. To circumvent this problem, a newer and safer approach is sought. Ultrasound-accelerated thrombolysis is a relatively newer and safer approach that requires local administration of thrombolytic agents. Herein, we report a case series of five patients who underwent ultrasound-accelerated thrombolysis with notable improvement in symptoms and right ventricular function. |
| format | Article |
| id | doaj-art-4bf1ad10b38e4274ba60484f9f4a3034 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-4bf1ad10b38e4274ba60484f9f4a30342025-02-03T05:51:36ZengWileyCase Reports in Medicine1687-96271687-96352014-01-01201410.1155/2014/297951297951Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary EmbolismSachin Kumar Amruthlal Jain0Brijesh Patel1Wadie David2Ayad Jazrawi3Patrick Alexander4Department of Cardiology, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI 48075, USADepartment of Internal Medicine, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI 48075, USADepartment of Internal Medicine, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI 48075, USADepartment of Cardiology, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI 48075, USADepartment of Cardiology, Providence Hospital and Medical Center, 16001 W Nine Mile Road, Southfield, MI 48075, USAAcute pulmonary embolism (PE) can be devastating. It is classified into three categories based on clinical scenario, elevated biomarkers, radiographic or echocardiographic features of right ventricular strain, and hemodynamic instability. Submassive PE is diagnosed when a patient has elevated biomarkers, CT-scan, or echocardiogram showing right ventricular strain and no signs of hemodynamic compromise. Thromboemboli in the acute setting increase pulmonary vascular resistance by obstruction and vasoconstriction, resulting in pulmonary hypertension. This, further, deteriorates symptoms and hemodynamic status. Studies have shown that elevated biomarkers and right ventricular (RV) dysfunction have been associated with increased risk of mortality. Therefore, aggressive treatment is necessary to “unload” right ventricle. The treatment of submassive PE with thrombolysis is controversial, though recent data have favored thrombolysis over conventional anticoagulants in acute setting. The most feared complication of systemic thrombolysis is intracranial or major bleeding. To circumvent this problem, a newer and safer approach is sought. Ultrasound-accelerated thrombolysis is a relatively newer and safer approach that requires local administration of thrombolytic agents. Herein, we report a case series of five patients who underwent ultrasound-accelerated thrombolysis with notable improvement in symptoms and right ventricular function.http://dx.doi.org/10.1155/2014/297951 |
| spellingShingle | Sachin Kumar Amruthlal Jain Brijesh Patel Wadie David Ayad Jazrawi Patrick Alexander Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary Embolism Case Reports in Medicine |
| title | Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary Embolism |
| title_full | Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary Embolism |
| title_fullStr | Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary Embolism |
| title_full_unstemmed | Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary Embolism |
| title_short | Unloading of Right Ventricle and Clinical Improvement after Ultrasound-Accelerated Thrombolysis in Patients with Submassive Pulmonary Embolism |
| title_sort | unloading of right ventricle and clinical improvement after ultrasound accelerated thrombolysis in patients with submassive pulmonary embolism |
| url | http://dx.doi.org/10.1155/2014/297951 |
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