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Respiratory: chest pain





What risk factors increase the chance of this condition?

What would be the most appropriate way of confirming the respiratory diagnosis?

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  • Is given as an injection
  • Reversed using protamine sulphate
  • Is potentiated by alcohol
  • Works by inhibiting vitamin K reductase, necessary for clotting factors 10, 9, 7 and 2.
  • Monitored by measuring the prothrombin time (which is standardised as INR)
  • Acts on the extrinsic pathway of coagulation
  • Reversed by giving vitamin K, fresh frozen plasma or prothrombin complex concentrates
  • Monitored by activated partial thromboplastin time (APTT)
  • Acts on anti-thrombin III
  • Acts on the intrinsic pathway of coagulation
  • Is taken as a tablet
  • Causes problems in pregnancy

After being admitted for several hours (mostly waiting for the investigation to be done), she admits that she thinks that it is odd that she developed this condition, and she asks if there are any underlying problems that could have set it off?

Kathryn is discharged later that day, not too happy about having to take warfarin and attend the anticoagulation clinic (which involves blood tests of which she is not keen on), and to make matters worse she has to see the GP about alternative contraceptive measures. What would be the best contraceptive option to advice to Kathryn?

 
Kathryn is discharged and lives happily ever after as the GP appropriately manages her contraceptives whilst the anticoagulation clinic vigilantly monitors her INR and warfarin dosing. She also saves a bundle as she is unable to drink.
 
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DVT

Notice the right leg is swollen and redder than the left, consistent with a DVT. © National Blood Clot Alliance.

Association between DVT and PE.










CTPA

CT pulmonary angiogram (CTPA) demonstrating intraluminal filling defects in the pulmonary arteries indicative of PE. © 2004 AuntMinne.com.







VQ 1

VQ2

VQ scan. Image A shows ventilation whilst image B shows perfusion. There is a clear mismatch between ventilation (V) and perfusion (Q), which is indicative of a PE. © 2004 Patrick Reinartz.