The most common cause of acute cor-pulmonale is
Correct Answer: Pulmonary thromboembolism
Description: Anticoagulation The main principle of treatment for PE is anticoagulation Thrombolytic and surgical therapy Thrombolysis is indicated in any patient presenting with acute massive PE accompanied by cardiogenic shock. In the absence of shock, the benefits are less clear but thrombolysis may be considered in those presenting with right ventricular dilatation and hypokinesis or severe hypoxaemia. Patients must be screened carefully for haemorrhagic risk, as there is a high risk of intracranial haemorrhage. Surgical pulmonary embolectomy may be considered in selected patients but carries a high moality. Caval filters A patient in whom anticoagulation is contraindicated, who has suffered massive haemorrhage on anticoagulation, or recurrent VTE despite anticoagulation, should be considered for an inferior vena caval filter. Retrievable caval filters are paicularly useful in individuals with temporary risk factors. The caval filter should be used only until anticoagulation can be safely initiated, at which time the filter should be removed if possible. General measures Prompt recognition and treatment are potentially life-saving. Sufficient oxygen should be given to hypoxaemic patients to maintain aerial oxygen saturation above 90%. Circulatory shock should be treated with intravenous fluids or plasma expander, but inotropic agents are of limited value as the hypoxic dilated right ventricle is already close to maximally stimulated by endogenous catecholamines. Diuretics and vasodilators should also be avoided, as they will reduce cardiac output. Opiates may be necessary to relieve pain and distress but should be used with caution in the hypotensive patient. External cardiac massage may be successful in the moribund patient by dislodging and breaking up a large central embolus. Ref Davidson edition23rd pg 642
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