Pulmonary embolism in the COVID-19 pandemic era: Importance of bedside electrocardiography, echocardiography and use of Tenecteplase.
Keywords:
COVID-19, pulmonary embolism, tenecteplase, electrocardiography, echocardiographyAbstract
Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs. Globally, it is the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke. This is a 43-yearold Nigerian diabetic man who had liposuction three weeks before presenting with sudden onset breathlessness, productive cough, chest pain, fever, inability to complete a sentence and inability to carry out his normal daily activities during this coronavirus 2019 (COVID-19) pandemic. He was tachypneic, tachycardic, hypotensive with rapidly dropping oxygen saturation (84%-86%, 80%-84%). This presented a diagnostic challenge which was rapidly resolved with bedside electrocardiography and echocardiography. A diagnosis of pulmonary embolism was sustained. Subsequent SARS-COV-2 PCRbased test was negative. He was successfully managed with an antithrombotic agent, tenecteplase, without any adverse events.
References
Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am. J. Prev. Med. 2010 Apr 1;38(4):S495-501.
Elegbeleye OO, Femi-Pearse D. Pulmonary embolism in Africans. Trop. geogr. med. 1975 Mar 1;27(1):31-3.
Casazza F, Becattini C, Bongarzoni A, Cuccia C, Roncon L, Favretto G, et al. Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER). Thromb Res. 2012 Dec 1;130(6):847-52.
Bompard F, Monnier H, Saab I, Tordjman M, Abdoul H, Fournier L, et al. Pulmonary embolism in patients with COVID-19 pneumonia. Eur. Respir. J. 2020 Jul 1;56(1).
Saleh JA, Alasia DD. Acute pulmonary embolism: a review. Niger J Med. 2007 Aug 16;16(1):11-7.
Worsley DF, Alavi A. Comprehensive analysis of the results of the PIOPED study. J. Nucl. Med. 1995 Dec 1;36(12):2380-7.
Tapson VF. Acute pulmonary embolism. N. Engl.
J. Med. 2008 Mar 6;358(10):1037-52.
Mos CM, Douma R, Erkens PM, Nizet TA, Durian MF, Hovens MM, et al. Performance of four clinical decision rules in the diagnostic management of acute pulmonary embolism; the prometheus diagnostic accuracy study. Ann. Med. 2011 June 7; 154(11): 709-18
Kucher N, Luder CM, Dornhofer T, Windecker S, Meier B, Hess OM. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J 2003;24:366-376
Vanni S, Polidori G, Vergara R, Pepe G, Nazerian P, Moroni F, et al. Prognostic value of ECG among patients with acute pulmonary embolism and normal blood pressure. Am. J. Med. 2009 Mar 1;122(3):257-64.
Shopp JD, Stewart LK, Emmett TW, Kline JA. Findings from 12-lead electrocardiography that predict circulatory shock from pulmonary embolism: systematic review and meta-analysis. Acad Emerg Med 2015;22:1127-1137.
Dresden S, Mitchell P, Rahimi L, Leo M, RubinSmith J, Bibi S, White L, Langlois B, Sullivan A, Carmody K. Right ventricular dilatation on bedside echocardiography performed by emergency physicians aids in the diagnosis of pulmonary embolism. Ann Emerg Med
;63:16-24.
Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G, Perrier A. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2015;36:605-614
Nikolaou K, Thieme S, Sommer W, Johnson T, Reiser MF. Diagnosing pulmonary embolism: new computed tomography applications. Journal of thoracic imaging. 2010 May 1;25(2):151-60.
Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Research Journal of Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Research Journal of Health Sciences journal is a peer reviewed, Open Access journal. The Journal subscribed to terms and conditions of Open Access publication. Articles are distributed under the terms of Creative Commons License (CC BY-NC-ND 4.0). (http://creativecommons.org/licences/by-nc-nd/4.0). All articles are made freely accessible for everyone to read, download, copy and distribute as long as appropriate credit is given and the new creations are licensed under the identical terms.
