Clinical profile, management and outcome of pulmonary embolism in Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

BACKGROUND AND AIMS: Pulmonary embolism (PE) is associated with a significant mortality and morbidity. We aim to study clinical profile, management and outcome of PE at Shahid Gangalal National heart Centre, Kathmandu, Nepal. METHODS: It was a retrprospective, single centre study, conducted from January 2015 to December 2016. Haemodynamics was used for risk Simplified, PESI score, predisposing factors, symptoms, clinical features at the time of admission, ECG features, echocardiogram, treatment received and the outcome were reviewed. RESULTS: During the study period 23 cases of PE were admitted. Nine were males and 14 were females. Eleven patients were diagnosed as provoked PE. High risk PE was diagnosed in four patients, Non-high risk in 19 patients. The most common clinical presentation was shortness of breath. The most common finding in ECG is sinus tachycardia followed by ST-T changes in V1-V3. Eight patient had SPO2 less than 90%. Most of the patients had a normal chest radiograph. Echocardiography revealed dilated RA and RV in 20 patients.All high risk PE patients were thrombolyzed with streptokinase. All patients who were diagnosed as Non-high risk PE were treated with LMWH. All the patients were treated with oral anticoagulants. Mean hospital stay was 9.7 ± 4.9 days. Two patients died during hospital stay. S-PESI score was 1.4 ± 0.9 respectively. Mean warfarin dose at the time of discharge was 5.9 ± 1.6 mg. CONCLUSION: PE is an under diagnosed clinical problem world over. Suspicion is the most important part to come to the diagnosis of PE.

Fibromuscular dysplasia in an adult male as a cause of renal artery stenosis and secondary hypertension treated with renal artery stenting.

BACKGROUND: Renovascular hypertension due to fibromuscular dysplasia is an uncommon cause of secondary hypertension and is more common in females. This entity is an important treatable cause of secondary hypertension. CASE PRESENTATION: We report the case of a 21-year-old asymptomatic male found to have high blood pressure on routine checkup. Renal angiogram revealed fibromuscular dysplasia involving the right renal artery. He underwent percutaneous angioplasty with complete recovery. The single antihypertensive which he was on was stopped next month. CONCLUSION: Fibromuscular dysplasia causing stenosis of renal artery is uncommon. High degree of suspicion is required for the timely diagnosis and treatment of this potentially treatable cause of secondary hypertension.