2007, Number S1
Diagnóstico de la tromboembolia pulmonar
Bautista-Bautista EG, Gutiérrez-Fajardo P, Ramírez A, Hernández-Hernández J
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Language: Spanish
References: 13
Page: 19-24
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ABSTRACT
It is mandatory to classify patients as having or not history of cardiopulmonary disease based on the cardiopulmonary response, degree of vascular occlusion, pulmonary arterial hypertension (PAH), and clinical and echocardiographical data of right ventricular dysfunction (RVD). One should consider those patients with limited cardiopulmonary function because, the incidence of pulmonary is high with rosen levels of mortality and cardiogemic shock. Suspicion of PT requires: ›1 risk factor for deep vein thrombosis; co-morbidities and clinical symptoms and signs; electrocardiographic and radiographic data; and demonstration of hypoxemia and/or thrombosis. In a patient with chronic neumopathy or cardiopathy, clinical data correlates with the degree of obstruction, PHA and RVD: sustained sudden dyspnea, syncope, anterior chest pain, shock or cardiorespiratory arrest. PT should be suspected in a high risk ambulatory or hospitalized patient receiving or not thromboprophylaxis suffering a sudden exacerbation of his pulmonary or cardiovascular disease without a triggering factor. Neither the chest roentgenogram nor the electrocardiogram are useful for the diagnosis. Hypoxemia is not universal and a normal P(A-a)O2 does not excludes the diagnosis. Sensibility of D-dimer test is ›99%. Cardiac troponins and cerebral natriuretic peptide are useful in some specific cases. The transesophagic echocardiogram diagnoses and stratifies a PT. Ventilatory/perfusory gammagraphy is a low-cost, non-invasive test that allows to repeatedly evaluate the lung perfusion. Selective pulmonary angiography is the gold standard test to diagnose PT (sensibility = 98%; specificity = 95-98%). If the PT is large and is centrally located it can be diagnosed by a chest computed tomography scan. Novel techniques such as pulmonary angiotomography are useful for PT diagnosis although they are expensive.REFERENCES
Guías de la Sociedad Mexicana de Cardiología para la estratificación, diagnóstico y tratamiento de la tromboembolia pulmonar aguda. Jerjes–Sánchez C, Elizalde GJ, Sandoval J, Gutiérrez–Fajardo P, Seoane GLM, Ramírez–Rivera A, Bautista E. Arch Cardiol Mex 2004; Arch Cardiol Mex 2004;74(supl):S548–S555.