Friday, July 14, 2006

Answer to CL case

Jane left a response to an earlier case study

Is her "chest pain" due to pulmonary hypertension due to prior pulmonary emboli with ongoing PEs? If she had acute PE with sudden rise in RV pressures to 70 that could explain her chest pain and hypotension. However the comment that the RA and RV were very dilated suggests this is a chronic process. It is not clear if she was on coumadin at the time of admission or just on it in the past. She needs chronic anticoagulation and to be treated with heparin until her INR is therapeutic. If she had already been on coumadin at the time of admission, then would want to consider a filter as well.

Yes Jan, you are very correct. This lady developed a leg swelling, a day after admission, raising the possibility that the chest pains may have been due to recurrent submassive pulmonary emboli. She was not on warfarin on admission. So I started her on subcut Clexane and warfarin. She recovered well and when she was stable for 3 days, she was ambulated and subsequently discharged well.

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