Pulmonary embolism is considered one of the “great masqueraders” of medicine. This means that it is easy to miss pulmonary embolism symptoms if you do not make sure to think about them in advance. Pulmonary Embolism Symptoms First, many pulmonary embolism patients do not experience any symptoms at all. We sometimes see an incidental pulmonary…
A splenic infarct can be the result of distal embolization, local thrombosis or arterial dissection. Diagnosing and treating the cause is central to management. Splenic Infarct Causes A splenic infarct is the result of one of the following mechanisms: Diagnosis Patients usually present with abdominal pain. But sometimes the finding is incidental. The diagnosis of…
A deep vein thrombosis, DVT, is a blood clot in the veins. It is one of the presentations of venous thromboembolism. The other is, of course, pulmonary embolism. A DVT can occur in the veins of the upper or lower extremity. They can also occur in the deep veins of the abdomen. Technically, it can…
A saddle PE is a pulmonary embolism that is located over the main pulmonary arteries. Perhaps surprisingly, many patients do not have symptoms. In fact, many had imaging for another reason and the PE was an incidental finding. However, sometimes these central clots block cardiac outflow enough to cause syncope, acute right heart failure and…
Many patients who suffered a DVT are worried about potential complications. They are concerned that they may have another clot. They are worried about the side-effects of treatment. Some patients ask about whether the clot can travel to their brain or to their heart. These questions come up a lot. So, I thought I would…
Catheter based interventions for pulmonary embolism is on the rise. The rise in mainly in patients who present with submassive PE. The intent of intervention is to reduce clot burden. This is done to improve acute symptoms and to reduce long-term complications. A common intervention for pulmonary embolism is infusion of thrombolytics. This can be…
There are several unique issues related to anticoagulation that are relevant to women in childbearing age. Menstrual bleeding on anticoagulation is one of those issues. It can range from discomfort to life-threatening blood loss. Managing menstrual bleeding in anticoagulated patients requires a balance of bleeding severity and thrombosis risk. Patient Evaluation for Menstrual Bleeding On…
Symptomatic patients who present with pulmonary embolism will present with shortness of breath and chest pain. Acutely, their functional capabilities are limited. While most patients post pulmonary embolism recover, many linger. Some patients who have suffered a pulmonary embolism will report limitations many months after the event. This is most pronounced after submassive- and massive…
Extra-Corporeal Membrane Oxygenation (ECMO) has been used to stabilize patients who are hemodynamically unstable for various reasons. Examples include septic patients and patients post massive myocardial infarction. Indeed, some pulmonary embolism (PE) patients require immediate hemodynamic stabilization. Often, these are the sickest of PE patients and without stabilization mortality is high. The idea behind using…
Yup. You read the title correctly. True. There is a large body of data regarding IVC filter misuse, lack of proven benefit, and associated complications. I agree. Completely. I too think that IVC filters are being overutilized, placed for the wrong indications, and do not benefit most patients. I also agree that there is evidence,…
