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There has been a lot of attention about pulmonary embolism recently in connection with the side effects following the administration of AstraZeneca. However, pulmonary embolism is also linked to the coronavirus itself. Recently, it became necessary to treat pulmonary embolism in an 84-year-old female patient who had previously experienced COVID-19.
At the beginning of March 2021, an 84-year-old patient, a retired nurse, was qualified for urgent surgical treatment at the Medicover Hospital. In February, she was infected with coronavirus with great weakness, accompanied by shortness of breath, fever and muscle aches. She went to the hospital because of increased dyspnoea and heart rhythm disturbances. After computed tomography, acute pulmonary embolism was diagnosed, and echocardiography revealed free thrombus in the right heart cavities. Despite a different mechanism of the emergence of “classic” pulmonary embolism from that in the course of COVID-19, in this case the pulmonary embolism had a specific relationship with the course of the coronavirus
How did COVID-19 affect the patient’s pulmonary embolism?
– Today we know that COVID-19 is very conducive to the formation of thrombosis. In most cases of “embolism” found in the pulmonary arteries in the course of COVID, it is a thrombotic material that was formed locally and did not come from the venous system, as is the case with “classic” pulmonary embolism – explains Dariusz Zieliński, cardiac surgeon from Medicover Hospital.
Zieliński adds that statistically, in the course of respiratory failure caused by coronavirus, the risk of clotting in the pulmonary placenta is several times greater than in the course of other acute respiratory failure, and it concerns a dozen or so percent of patients hospitalized in intensive care units.
– Most often, the ’embolic’ material (in fact, obstructed pulmonary vessels due to local thrombosis) occurs in the area where the lung parenchyma is already damaged by COVID-19, he says. – In this particular patient, immobilization was the most likely mechanism of embolism, due to a marked decline in COVID-19. Additionally, the high fever caused dehydration. It is worth remembering that older people are more prone to dehydration in the course of fever because they have a disturbed sense of thirst. Dehydration causes “thickening” of the blood, which, combined with immobilization, favors the formation of blood clots in the venous system – summarizes Dariusz Zieliński.
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In patients with acute pulmonary embolism with thrombus in the heart cavities, there is a very high risk of death in the case of conservative treatment, therefore the patient was immediately operated on under the supervision of doctor Dariusz Zieliński.
The patient underwent pulmonary artery embolectomy (i.e. removal of embolic material from the pulmonary arteries), as well as elimination of thrombus from the right atrium of the heart. The operation and rehabilitation were both successful. And the success is all the greater when you consider the patient’s baseline status, age, and the level of complexity of the procedure.
How to recognize a pulmonary embolism and what is conducive to its formation?
The most common symptoms of pulmonary embolism include: limited exercise tolerance, dyspnea at rest, unusual chest pains, coughing, fainting or loss of consciousness may occur. If these symptoms are accompanied by unilateral lower limb pain with edema, the probability of pulmonary embolism increases significantly. Distinguishing the “classic” form of this disease from complications of COVID-19 allows computed tomography (CT) examination.
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– Factors contributing to the development of embolism are: long-term immobilization, major surgical procedures, fractures and extensive injuries, contraceptives, hormone replacement therapy, neoplastic diseases, previous deep vein thrombosis, varicose veins of the lower extremities, thrombophilia – i.e. congenital coagulation disorders – comments the cardiac surgeon from the Hospital Medicover.
The Department of Cardiac Surgery at the Medicover Hospital is part of the PERT-CELZAT team (together with the European Health Center in Otwock). It is a multidisciplinary team of specialists experienced in the treatment of acute pulmonary embolism, available 24 hours a day, activated in cases of acute pulmonary embolism whose course is life-threatening. This team determines the best treatment for patients with acute pulmonary embolism, regardless of where the patient is (this may also be at the site of reporting). If the patient qualifies for surgery, he or she is admitted to the Medicover Hospital.
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