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Abstract: The patient was a 61-year-old female who had been diagnosed with pulmonary embolism for 2 months at an outside hospital and had chest tightness for 1 day, so she came to our hospital for further diagnosis and treatment. After admission and completion of relevant examinations, the preliminary diagnosis of pulmonary embolism was made. After 2 days of anticoagulation, blood pressure control medication and general conditioning treatment, the condition basically stabilized and the symptoms of chest tightness were relieved, and the pulmonary artery embolism was obviously absorbed after 2 months of examination.
Basic information】Female, 61 years old
Disease Type】Pulmonary embolism
Hospital】The First Hospital of China Medical University
Date of consultation】September 2021
Treatment plan】Oral medication (warfarin sodium tablets, nifedipine tablets)
Treatment Period】Hospitalization for 2 days, review after 2 months
Treatment effect] The condition was basically stable, and the pulmonary artery embolism was significantly absorbed
I. Initial consultation
When we first saw the patient, he presented with a normal face, and his body shape and nutrition were normal. He reported a history of pulmonary embolism for 2 months and chest tightness for 1 day. Physical examination showed that T: 36.2℃, P: 72 beats/min, R: 18 beats/min, BP: 155/80mmHg, clear percussion, coarse breath sounds in both lungs, no dry and wet rales or pleural fricative sounds were heard, normal voice conduction; the heart rhythm was uniform and no valvular murmur was heard. After admission, the patient was given a CTA examination of the pulmonary artery, which showed that the lumen of the main pulmonary artery was not significantly thickened, the lumen was well filled with contrast, and patchy low-density filling defects were seen in the distal pulmonary artery and branches. The initial diagnosis was pulmonary embolism, and the patient was admitted to the hospital for treatment.
Treatment history
After the patient was admitted to the hospital, the relevant examinations were completed, and the pulmonary artery CTA: after the treatment of pulmonary embolism, it was significantly better than the previous film on July 20, 2021. Lower limb vascular ultrasound: left calf muscle interstitial vein thrombosis after treatment, bilateral lower limb atherosclerotic plaque formation, bilateral calf muscle interstitial vein dilatation. Combined with the above examination results, anticoagulation and blood pressure control medication were given. The patient was given warfarin sodium tablets for thrombolysis and anticoagulation, which in turn relieved the pulmonary embolism. The patient also needs to be given nifedipine tablets medication to lower the blood pressure level. On the second day of admission, the patient’s condition was more stable and was given discharge medication.
III. Treatment effect
After the patient was treated with regular anticoagulation and antihypertensive drugs, the patient’s chest tightness was reduced on the first day of admission, and on the second day of admission, the chest tightness disappeared completely and the condition was more stable, and the patient was discharged with satisfactory treatment effect. When the patient came to the hospital for review 2 months after discharge, the patient indicated that he did not have chest tightness, and CTA examination of pulmonary artery was given, which showed that the bilateral pulmonary embolism was obviously absorbed, and he still needed to continue to take medication and come to the hospital for review regularly.
IV. Precautions
The patient’s condition was basically controlled after regular drug treatment, and I am sincerely very happy, but the following issues should still be noted.
1. Patients can choose to do appropriate activities after discharge, such as walking and jogging, to avoid being sedentary and thus aggravating the disease.
2, patients need to pay attention to avoid eating greasy, high-fat food, such as fried chicken, fatty meat, etc., in their daily diet, so as not to cause an increase in blood lipid levels, which in turn increases the chance of thrombosis.
3.After discharge from the hospital, patients should go to the hospital regularly for review under the guidance of the doctor, and they should take the medication regularly.
4.Patients are advised to pay attention to rest and avoid staying up late and overworking, which can also promote disease recovery.
V. Personal insight
Pulmonary embolism is a kind of disease caused by thrombus embolism of pulmonary artery, resulting in dysfunction of pulmonary circulation and right heart, and the patient is prone to chest tightness, hemoptysis, chest pain, cough, dyspnea and even syncope, which needs active treatment. The patient in this case has a history of lower extremity arterial thrombosis, which is an important cause for the development of his pulmonary embolism. After the patient’s condition is stabilized, active prevention and treatment of lower extremity arterial thrombosis is also needed to avoid the recurrence of pulmonary embolism.