If you had a PE, you'd be much sicker, though, the fact that you were on a long trip and the fact that you did have a cough and chest pain are rather concerning. At any point did you feel your heart beating really fast? The classic signs of PE are: fainting, coughing up blood and pleuritic chest pain (i.e. sharp chest pain when you breathe in)....however, the most sensitive sign for pulmonary embolus given the right clinical scenario is tachycardia.
Shortness of breath is another symptom, but you didn't mention that. Have you been short of breath at all?
You're obviously very knowledgable about medicine, but to be honest, I think it might be doing you more harm than good
I disagree with you about one thing...the healthcare here might need revamping, but it's not bad. In fact, we have some of the most highly regarded health care in the whole world--it's just that we expect so much out of it that it's become very strained.
For treating things like suspected PE, MIs etc. etc. etc. the treatment here is impeccable...in fact, there is a guy in London, ON who does ground-breaking research in the management of PE/DVT. I didn't realize that you have had a PE before. Go to the ER!! You're at further risk of having a PE if you'd had one before.
I realize that I am at risk of developing further PE. With the CHF, upper respiratory infections, repeated pneumonia, Latent TB and recent flu exposure the cross-over of symptoms become a little cloudy. As time goes on I doubt that it is PE, unless it has broken up on its own. I am unsure but it seems unlikely that after two days it would still be hanging around. And, if so...seems it would be a much quicker end than I can expect as the CHF worsens.
True, but if I may, you're not a doctor, and even a doctor would, in your case, at least send you for a spiral CT. The thing is, the PE still may be "hanging around", and it can be exacerbating things like you said. By the way, before you were saying that you were hypertensive and not hypotensive like it normally happens with PE....I think there may have been some confusion because it is almost impossible to have hypertension with PE.....are you sure you didn't have PULMONARY hypertension? That might be what you have right now if there is in fact something wrong....and CHF, have you had that too, or is that just something you know is a complication? The other thing is that it is usually cor pulmonale + right-sided heart failure you get with PE, but that's usually only in massive PE.
Also, you keep mentioning reactivation of latent TB....why are you considering this as a possibility? Do you have a history of reactivation of a past infection?
Last edited by butterflytrans; 01-02-2004 at 02:55 PM.
1) Possibly but not always in our area (they are not likely to call personnel in on weekends, holidays or evenings)
This totally depends on how serious it is though. It is against the standard of care to not call someone in an emergency situation just because it's a weekend. If they think it can wait 'till Monday, THEN they won't call the personnel. I mean, a massive PE is just as serious as a massive MI. It's not like they wouldn't call in the CCU person on call if someone presented with symptoms of an MI
2) Had the scan with the dye. Doctor said PE. Pumped me full of Heparin.
Well! I'm glad they treated you! How long were you anticoagulated for?
3) CHF is a result of ??? ("doctors" can't agree) -- hypertrophic (side??) but still compensating -- hence still tachycardic -- or so they tell me -- have another ultrasound of heart later in the month -- will pay more attention this time I guess.
There are two types of CHF--which normally refers to left-sided heart failure)--they are systolic and diastolic.
Systolic CHF has an abnormal EF (<55%) and is caused by the following:
Right-Sided heart failure is also an issue in some patients. The most common cause of right-sided heart failure is left sided heart failure. However, you can have isolated right sided heart failure in patients with pulmonary hypertension as in: COPD, Idiopathic Pulmonary Fibrosis, Pulmonary Embolus etc.
You are just too funny. Our son was hurt in at a hockey game (head first into the boards) a month ago. The doctor at the clinic requested C-Spine... URGENT. We got to the hospital and they sent us away because they were putting up Christmas decorations and wouldn't get to us for hours. We ended up driving him to a hospital west of us. The doctor took the x-rays and then said there was so much swelling he couldn't read them so he fitted my son with a collar, gave him anti-inflammatories (which gave him a bleeding ulcer) and told us to come back in three days.
I also disagree that you'd be 'much sicker' if you had a PE. PE's can be so screwy to diagnose precisely because not everybody who has one is super-sick.
You're right...but I should have been clear that I was talking about a massive PE. I guess I keep forgetting that you can have small ones that cause transient pain but are eventually dealt with by the body.
It is also not impossible to have hypertension with PE.
Prolonged tachycardia could cause prolonged hypertension, and tissue hypoxia from anemia could trigger prolonged tachycardia, so in a way they could all agree
True, but prolonged tachycardia will only cause hypertension if the stroke volume of the heart is also high. Often with a massive PE, you get pulmonary hypertension which results in acute right heart failure and massive congestion in the venous system. The heart ends up pumping very quickly (thus tachycardia being a very sensitive sign, in the right clinical scenario for PE) to try to MAINTAIN blood pressure, but without the stroke volume, you're either normotensive or hypotensive...at least eventually....I mean, right for the first few minutes after you've had the PE, maybe you're hypertensive--but it doesn't last long.
The other thing is, there are 10 main reversible causes for asystole (which I'm sure we can all agree is quite a low blood pressure) and pulmonary embolus is one of them.
Those statements weren't meant to go together, hence the paragraphing.
yes, yes, blah blah, mary had a little lamb, I get it. I am saying that textbook answers are not always correct, because patients don't read textbooks. The best doctors I've ever known were doctors who weren't afraid to say 'maybe'.