Ajah Ogbonnaya N
Department of Emergency Medicine, Barnet General Hospital, London, GBR.
Cureus. 2024 Sep 30;16(9):e70561. doi: 10.7759/cureus.70561. eCollection 2024 Sep.
Pulmonary embolism (PE) occurs when thrombi from deep vein thrombosis dislodge and obstruct pulmonary arteries, raising pulmonary artery pressure and straining the right ventricle. This strain can lead to right ventricular dysfunction (RVD), characterized by reduced cardiac output, impaired contractility, and potential development of chronic thromboembolic pulmonary hypertension. Clinically, PE may present with symptoms such as dyspnea, pleuritic chest pain, and tachycardia. Diagnosis is typically confirmed through computed tomography pulmonary angiography, biomarkers like D-dimer and cardiac troponins, and clinical scoring systems. Acute management focuses on hemodynamic support, including intravenous fluids and vasopressors, and may involve anticoagulation with low-molecular-weight heparin or direct oral anticoagulants. Severe cases may require systemic anticoagulation, catheter-directed techniques, and surgeries like pulmonary endarterectomy. Long-term management involves continued anticoagulation tailored to individual risk factors, with ongoing monitoring to prevent recurrence. Effective early diagnosis and management are crucial, as severe PE can significantly increase mortality and lead to serious complications. This review explores the pathophysiology, diagnosis, and management of PE and RVD.
当深静脉血栓形成的血栓脱落并阻塞肺动脉时，就会发生肺栓塞（PE），从而导致肺动脉压力升高并使右心室负担加重。这种负担会导致右心室功能障碍（RVD），其特征是心输出量减少、收缩力受损以及可能发展为慢性血栓栓塞性肺动脉高压。临床上，PE可能表现为呼吸困难、胸膜炎性胸痛和心动过速等症状。诊断通常通过计算机断层扫描肺动脉造影、D-二聚体和心肌肌钙蛋白等生物标志物以及临床评分系统来确诊。急性处理重点在于血流动力学支持，包括静脉输液和血管加压药，可能还涉及使用低分子量肝素或直接口服抗凝剂进行抗凝治疗。严重病例可能需要全身抗凝、导管介入技术以及诸如肺动脉内膜切除术等手术。长期管理包括根据个体风险因素持续进行抗凝治疗，并持续监测以预防复发。有效的早期诊断和管理至关重要，因为严重的PE会显著增加死亡率并导致严重并发症。本综述探讨了PE和RVD的病理生理学、诊断和管理。
