Pulmonary Embolism (PE)

Posted By zhiyuan on June 01, 1998 at 05:10:19:







Dear Sir,
My teacher is currently suffering from Pulmonary Embolism (PE).
The symptoms is as follows:

I. CLINICAL MANIFESTATION
     =


Palpitation, pant, cough, shortness of breath. Breath becomes even harder
at night making sleep difficult. The symptoms become more serious when
climate changes.
II. EXAMINATION RESULTS
    =


1. Idiopathic rapid heart rate (ventricular tachycardia)
2. Pulmonary ventilation perfusion scanning:
   Image of inhalating ventilation is normal for both left and right lobes
   of lung. Blood-stream perfusion on right lobe of lung shows multiple
   focal radiation sparse area; perfusion and ventilation do not match.  
   Multiple chronic pulmonary embolism (PE) is possible on both lobes of
   lung.
3. Lower-extremity angiogram (bloodstream image):
   Incomplete obstruction at the intersection point of lower-segment of
   femoral vein and upper-segment of popliteal vein on left lower-extremity.
   Varicose vein on left lower-limb. Venous return deep in the right
   lower-limb is basically normal.
III. DIAGNOSIS
      =
1. Idiopathic rapid heart rate (ventricular tachycardia)
2. Multiple chronic pulmonary embolism (PE) on both lobes of lung
3. Varicose vein on left lower-limb, incomplete obstruction.
IV. TWO SUGGESTED METHODS OF THERAPY



  
1. Conservative Therapy:
   A.   Oral Medication: Solvent, anti-coagulant.
         Raise the troubled limb. Wear stretch socks.  
        
   B.   Venous Transfusion: (streptokinase ?)
2. Operative Treatment
  
   Holder on the inferior cava, following X-ray lower-limb phlebography
   and pulmonary arteriography.
V. CURRENT THERAPY
      


  
   Currently, only oral medication is taken.
   No venous transfusion. No operation therapy.
VI. MEDICATION



1.  Medication during hospitalization:
    Ticlid,                     1 tab once (0.25mg), 1 times / day
    Tabellae Dipyridamoli,      1 tab once (5mg), 3 times / day
    Concor 5,                   1 tab once (5mg), 1 times / day
2.  Current medication:
    Lumbrokinase Capsule,       2 tab once, 3 times / day
    Enteric soluble Aspirin,    4 tab once (0.25mg), 1 times / day
    Tabellae Dipyridamoli,      1 tab once (5mg), 3 times / day
    Tabellae Propafenoni Hydrochloridi, 3 tab once (50mg), 3 times / day
    
VII. QUESTIONS:
=


1. Is the above diagnose accurate?
   Is it necessary  to further receive testing such as X-ray lower-limb
   phlebography and pulmonary arteriography?
2. When the symptoms of hard-breathing clearly occur, the examinations such
   as electrocardiogram (ECG) and pulmonary computed tomography (CT) show
   normal results, why is this so?
3. Currently, only oral medication is taken. Is it possible to achieve the
   expected therapeutic result by medication therapy only?
4. Can venous transfusion (streptokinase ?) achieve the expected
   therapeutic result?
5. Is the operation unavoidable?
6. Is there any other way and other medication based on the above mentioned
   symptoms?

Thank your very much
Sincerely yours.
zhiyuan