Tromboembolismo Pulmonar

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Este paciente tem TEP?

Alfredo N. C. Santana

Professor Adjunto, HRAN, Medicina ESCS, DF

Medicina - ESCS

Este paciente te TEP?

Alfredo N. C. Santana

Professor Adjunto, HRAN, Medicina ESCS, DF

Medicina - ESCS

bEchocardiographic criteria of RV dysfunction include RV dilation and/or an increased end-diastolic RV–LV diameter ratio (in most studies, the reported threshold value was 0.9 or

1.0); hypokinesia of the free RV wall; increased velocity of the tricuspid regurgitation jet; or combinations of the above. On computed tomographic (CT) angiography (four-chamber

views of the heart), RV dysfunction is defined as an increased end-diastolic RV/LV (left ventricular) diameter ratio (with a threshold of 0.9 or 1.0).

cMarkers of myocardial injury (e.g. elevated cardiac troponin I or -T concentrations in plasma), or of heart failure as a result of (right) ventricular dysfunction (elevated natriuretic

peptide concentrations in plasma).

Accordingly, normotensive

patients inPESI Class≥III ora simplified PESI of≥1 are considered

to constitute an intermediate-risk group.Within this category, further

risk assessment should be considered, focusing on the status of the

RV in response to the PE-induced acute pressure overload. Patients

who display evidence of both RV dysfunction (by echocardiography

orCTangiography) and elevated cardiac biomarker levels in the circulation

(particularly a positive cardiac troponin test) should be classified

into an intermediate-high-risk category.

On the

other hand, patients in whom the RV is normal on echocardiography

or CT angiography and/or cardiac biomarker levels are also normal,

belong to an intermediate-low-risk group.

routine performance of imaging or laboratory tests in the

presence of a low PESI or a simplified PESI of 0 is not considered

necessary at present as, in these cases, it has not been shown to

have therapeutic implications.

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