8-year follow-up of a successful outcome of massive pulmonary embolism with cardiogenic shock

Abstract

Currently pulmonary embolism (PE) is already on the 3rd place in terms of the frequency of occurrence among vascular diseases, and there is a global trend towards an increase in its frequency. PE is also considered as the most common cause of preventable death in the hospital. In the countries of Europe, Asia and the USA, there is a tendency to reduce the cases of fatal PE due to the use of more effective conservative therapy, invasive interventions and following the Recommendations. Since 2019, the European Guidelines for the diagnosis and treatment of PE have made the use of direct oral anticoagulants preferable in comparison with oral vitamin K antagonists.A case of massive PE in a 42-year-old patient developed in the specialized department of the hospital shortly after being transferred from the intensive care unit with verified PE of small branches (D-dimer, lung scintigraphy, Echo-cardiography) is presented. The debut of a massive PE in the form of a syncopal state with cardiogenic shock, required an urgent transfer of the patient to artificial lung ventilation, the use of vasopressors and systemic thrombolysis. During Echo-cardiography, a mobile blood clot was located in the right atrium. An emergency thrombectomy was performed from the pulmonary trunk and pulmonary arteries in conditions of artificial blood circulation, later a cava filter was installed. The features of anamnesis characteristic of PE (hormonal contraceptives), complaints (sudden shortness of breath, heaviness behind the sternum at admission) and concomitant pathology (drug-induced thyrotoxicosis) are analyzed.The results of the subsequent 8-year follow-up without relapses of PE are considered, the feature of which was the use of Rivaroxaban as an anticoagulant and angiovit (B vitamins – 6, 9 and 12) for the correction of hereditary hyperhomocysteinemia. Risk factors and modern standards of treatment of massive PE in the acute period and in the long term are discussed.

Keywords

• pulmonary embolism
• cardiogenic shock
• thrombolysis
• thrombectomy
• cava filter
• rivaroxaban