Bangladesh Journal of Cardiology(Vol. 01,No.02,September 2009) Official Publication of Labaid Cardiac Hospital

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Published on March 9, 2014

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Bangladesh Journal of Cardiology(Vol. 01,No.02,September 2009) Official Publication of Labaid Cardiac Hospital

Review Articles

Review Articles

Review Articles

Review Articles

158 Rahman M, Chakraborty B, Ali E et al. Bangladesh J Cardiol, 2009; 1(2): 158-60 Thrombolytic Therapy for Acute Pulmonary Embolism -A Case Report M Rahman, B Chakraborty, E Ali, M Rahman, A Monsur Labaid Cardiac Hospital, Dhaka, Bangladesh Abstract The authors report a case of acute pulmonary embolism (PE) in a young man who was treated with thrombolytic agent. The diagnosis was suggested by echo-Doppler study which showed dilated right ventricle (RV) and right atrium (RA) and calculated pulmonary artery (PA) pressure 90 mm of Hg. The diagnosis of PE was confirmed by pulmonary angiogram and he was treated with streptokinase for 24 hours with excellent clinical out come. He continues to remain in stable state at last follow up 5 weeks after discharge. (ECG) showed partial right bundle branch block with wide spread T wave inversion in chest leads (Fig-1). Introduction PE, most commonly originating from deep venous thrombosis of the legs, ranges from asymptomatic, incidentally discovered emboli to massive embolism causing immediate death.1 Although thrombolytic agents have been studied as a treatment of acute PE, to date there have been only 11 randomized controlled trials comparing thrombolytic therapy to conventional anticoagulation.2 Many studies confirm that thrombolytic therapy leads to rapid improvement in haemodynamic aberrations associated with PE, and this approach to massive PE with cardiogenic shock is guide-based practice.2-4 It is widely accepted that acute PE without associated RV dysfunction or haemodynamic instability can be readily managed with standard anticoagulation.1,2,5,6,7 Here we report case of a massive PE who responded well to thrombolyic therapy. FIGURE- 1 12 lead electrocardiogram (ECG) showed partial right bundle branch block with wide spread T wave inversion in chest leads. Bed side echo-Doppler study revealed dilated right ventricle (RV) and right atrium (RA) with severe tricuspid regurgitation (TR) with calculated pulmonary artery (PA) pressure 90 mm of Hg (Fig 2,3). Case Report A young man of 38 years of age was admitted in a hospital with complaints of progressive shortness of breath and cough for 10 days. His previous medical history was unremarkable. He did not give any history of hypertension, diabetes mellitus or bronchial asthma and he was non smoker. On admission his systemic clinical examination revealed tachycardia and tachypnoea along with raised jugular venous pressure (JVP). Auscultation of heart and lung did not reveal any abnormality. 12 lead electrocardiogram Dr Matiur Rahman, FRCP, Head of the Department of Cardiology Dr Baren Chakraborty, FRCP, Chief, Continuing Medical Education and Research Dr Md. Elias Ali, MD, Consultant Dr. Mahbubor Rahman, FACC, Senior Consultant Dr. A H M Abul Monsur, D. Card, Consultant Cardiologist Correspondence : Dr. Matiur Rahman, Head of the department of Cardiology, Labaid Cardiac Hospital, House 1, Road 4, Dhanmondi, Dhaka 1205, Bangladesh Tel: +880-2-8610793, 9670210-3, E-mail : mati.rahman@yahoo.com echo-Doppler study FIGURE- 2 Bed side (RV) and right atrium revealed dilated right ventricle (RA).

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