Depending on the severity of the embolus and the amount of lung tissue at risk, the patient may present critically ill in extremis with markedly abnormal vital signs, or may appear rather normal.
Physical examination may not be helpful, and the diagnostic studies are done upon clinical suspicion based on history and risk factors. The diagnosis may be made directly with imaging of the lungs or indirectly by finding a clot elsewhere in the body. The strategy used to make a diagnosis will depend upon each individual patient's situation, but there are some general tools available.
D-Dimer is a blood test that can measure breakdown products of blood clots in the body but cannot differentiate a pulmonary embolus from a healing scar from surgery, or a bruise from falling. If this test is negative, then a pulmonary embolus can usually be excluded if the patient is in a low risk category to form clots. Cancer and pregnancy are two other situations in which the D-Dimer test is often positive even without blood clots present.
Lungs can be imaged with a ventilation-perfusion scan or a CT scan to look for a clot. Each test has its benefits and limitations, and use of these tests is dependent upon the clinical situation. If there are technical issues so that the lungs cannot be imaged, an ultrasound of the legs may be performed to look for a thrombus; the concept is that if the symptoms are present of a pulmonary embolus and a clot is found in the leg, then the diagnosis can be inferred.
However, if the complete clot has broken free, the leg ultrasound may be normal even when a pulmonary embolism is present. Sometimes direct angiography of the pulmonary arteries may be performed. Catheters are placed into the pulmonary artery, and a dye is injected.
This test must be performed by a specially trained radiologist or cardiologist. The treatment for pulmonary embolus is anticoagulation using either heparin or enoxaparin Lovenox initially, and then transitioning to warfarin Coumadin for long-term treatment. The usual treatment course for anticoagulation for a pulmonary embolus is 3 to 6 months. The lungs and heart can stop working if there is a large enough clot load. Thrombolytic, or clot busting, therapy may be considered in addition to the basics of oxygen, intravenous fluids, and medicines to support blood pressure.
In rare and extreme cases, lytic agents may be directly injected into the area of clot. Pulmonary embolus should always be considered a life-threatening illness. For additional information, please read the Pulmonary Embolism article. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time. Angina and heart attack myocardial infarction Share Your Story The worry for patients and health care professionals is that any chest pain may originate from the heart.
Angina is the term given to pain that occurs because the coronary arteries blood vessels to the heart muscle narrow and decrease the amount of oxygen that can be delivered to the heart itself. This can cause the classic symptoms of chest pressure or tightness with radiation to the arm or jaw associated with shortness of breath and sweating. Unfortunately, many people don't present with classic symptoms, and the pain may be difficult to describe -- or in some people may not even be present.
Instead of angina or typical chest pressure, their anginal equivalent symptom they get instead of chest pain may be indigestion , shortness of breath, weakness , dizzyness, and malaise.
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Requests for amendment of PHI in a designated record set should be made to the privacy officer, Mr. You or your personal representative will be required to complete a form to request amendment of the PHI in your designated record set.
However, such accounting need not include PHI disclosures made: However, electronic health records disclosed for purposes of payment or health care operations are subject to your right to an accounting for disclosures made up to three years before the date of your request. If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.
If you request more than one accounting within a 12 month period, the Plan will charge a reasonable, cost-based fee for each subsequent accounting. A Note About Personal Representatives You may exercise your rights through a personal representative. Proof of such authority may take on of the following forms: The Plan retains discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
This also applies to personal representatives of minors. If your PHI is improperly accessed, acquired, used, or disclosed, the Plan will notify you, as required by law.
That notification may include a description of what happened, the information involved, and the steps you can take to protect yourself. This notice is effective beginning April 1, and the Plan is required to comply with the terms of this notice. However, the Plan reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Plan prior to that date.
If a privacy practice is changed, a revised version of this notice will be provided in writing to all past and present participants and beneficiaries for whom the Plan still maintains PHI. Minimum Necessary Standard When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations.
However, the minimum necessary standard will not apply in the following situations: This notice does not apply to information that has been de-identified. De-identified information does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual and is therefore not considered to be individually identifiable health information.
The Plan will not retaliate against you for filing a complaint. Whom to Contact at the Plan for More Information If you have any questions regarding this notice or the subjects addressed in it, you may contact the privacy officer, Mr. You may find these rules at 45 Code of Federal Regulations Parts and This notice attempts to summarize the regulations.
The regulations will supersede any discrepancy between the information in this notice and the regulations. ERISA provides that all plan participants shall be entitled to: Department of Labor, such as detailed annual reports and plan descriptions. Obtain copies of all plan documents and other plan information upon written request to the plan administrator.
The administrator may make a reasonable charge for the copies. In addition to creating rights for plan participants, ERISA imposes duties on the people who are responsible for the operation of the employee benefit plan. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit under this plan or exercising your rights under ERISA.
If your claim for a benefit under this plan is denied in whole or in part you must receive a written explanation of the reason for the denial.
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