Profile of pulmonary embolism in service personnel posted at high altitude area

Vijay Dutta, Rajeshwar Singh, Sandeep Kumar, Naveen Aggarwal, K V S Hari Kumar, Vijay Dutta, Rajeshwar Singh, Sandeep Kumar, Naveen Aggarwal, K V S Hari Kumar

Abstract

Background: We evaluated the clinical presentation and risk factors of pulmonary embolism (PE) in soldiers posted at high altitude areas (HAA).

Methods: We conducted a retrospective analysis of all cases of PE presented to us between March 2011 and Aug 2014. The patients were serving at an altitude between 10,000 and 22,000ft above sea level and PE was diagnosed using the pulmonary CT angiography. Screening for the deep vein thrombosis (DVT) and procoagulant conditions was done at presentation and after six months of treatment. The patients were managed as per the American College of Cardiology (ACC) guidelines and descriptive statistics were used to present the data.

Results: The patients (53 males) had a mean age of 33±4.2 year and were serving at a mean altitude of 12,176±448 feet (ranged between 10,000 and 20,500) at the onset of symptoms. Dyspnea (79%) and tachycardia (68%) were the commonest symptom and sign, respectively. D dimer was positive in 96.2% of the cases while nonspecific T inversion in the ECG was seen in 54.7% of the patients. Procoagulant work up revealed a hereditary thrombophilic condition in 9 out of 53 patients. A total of 44 cases were idiopathic and DVT of lower limb veins was seen in 2 patients. There was no mortality in our case series.

Conclusion: PE is a common complication of HAA and hereditary thrombophilia contributes in a minority of the patients. Further studies are needed to ascertain the risk factors of PE at HAA.

Keywords: Cold; High altitude; Pulmonary embolism; Soldiers; Thrombophilia.

Copyright © 2017. Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
CT angiography image showing PE in left pulmonary artery.
Fig. 2
Fig. 2
Hereditary thrombophilic conditions in patients with PE.

References

    1. Tapson V.F. Acute pulmonary embolism. N Engl J Med. 2008;358:1037–1052.
    1. Martinelli I., Bucciarelli P., Mannuccio P.M. Thrombotic risk factors: basic pathophysiology. Crit Care Med. 2010;38:S3–S9.
    1. Khan D.A., Hashim R., Mirza T.M., Matloob-ur-Rehman M. Differentiation of pulmonary embolism from high altitude pulmonary edema. J Coll Physicians Surg Pak. 2003;13:267–270.
    1. West J.B. The physiological basis of high-altitude diseases. Ann Intern Med. 2004;141:789–800.
    1. Anand A.C., Saha A., Seth A.K., Chopra G.S., Nair V., Sharma V. Symptomatic portal system thrombosis in soldiers due to extended stay at extreme high altitude. J Gastroenterol Hepatol. 2005;20:777–783.
    1. Shishir K. High altitude induced deep venous thrombosis: a study of 28 cases. Indian J Surg. 2006;68:84–88.
    1. Parakh R., Kapadia S.R., Sen I., Agarwal S., Grover T., Yadav A. Pulmonary embolism: a frequent occurrence in Indian patients with symptomatic lower limb venous thrombosis. Asian J Surg. 2006;29:86–91.
    1. Kearon C., Kahn S.R., Agnelli G., Goldhaber S., Raskob G.E., Comerota A.J. American College of Chest Physicians Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008;133(Suppl. 6):454S–545S.
    1. Khalil K.F., Saeed W. Pulmonary embolism in soldiers serving at high altitude. J Coll Physicians Surg Pak. 2010 Jul;20(7):468–471.
    1. Turan O., Ündar B., Günay T., Akkoçlu A. Investigation of inherited thrombophilias in patients with pulmonary embolism. Blood Coagul Fibrinolysis. 2013;24:140–149.
    1. Stein P.D., Gottschalk A., Sostman H.D. Methods of prospective investigation of pulmonary embolism diagnosis III (PIOPED III) Semin Nucl Med. 2008;38:462–470.
    1. Goldhaber S.Z., Visani L., De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) Lancet. 1999;353(9162):1386–1389.
    1. Wirtz H.P., Bärtschi C., Spillmann M., Ehlert U., Von Käne R. Effect of oral melatonin on the procoagulant response to acute psychosocial stress in healthy men: a randomized placebo controlled study. J Pineal Res. 2008;44(4):358–365.
    1. Gupta R., Joshi P., Mohan V., Reddy K.S., Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008;94:16–26.
    1. Girard P., Sanchez O., Leroyer C. Deep venous thrombosis in patients with acute pulmonary embolism: prevalance, risk factors, and clinical significance. Chest. 2005;128:1593–1600.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel