Book of Medical Disorders in Pregnancy - Tintash

may complain of constricting type of
pain due to fall in coronary blood flow.
The pati-ent may suddenly collapse, turn
cyanosed, sweat and gasp. There may be
no cough or hemoptysis.
PR segment
P
QRS Complex
R
ST segment
PR interval Q QT interval
S
Fig10.5: Shows normal ECG
The E.C.G. shows right ventricular strain
with T wave inversion in leads VLN2
and V3. Q wave is deep, T wave is
inverted in standard lead III, S wave is
inverted in standard lead I. These
changes remain for several days and are
most helpful in confirming the diagnosis.
Nearly 25 per cent of the patients die
with in an hour or two. A recurrent embolus
will occur in at least 25 per cent of
those who survive the first attack. This
may be prevented, if anti-coagulant
therapy is instituted in time.
A very large emulous can completely
block the outflow of blood from the right
ventricle and lead to sudden death within
a few seconds. Multiple small
pulmonary emboli may develop during
puerperium. They can obliterate
pulmonary arteries and in succeeding
months result in pulmonary hypertension.
As the months go by, the patient
becomes increasingly breathless and on
exertion may faint or develop anginal
T
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pain. Increasing pulmonary hypertension
causes right ventricular hypertrophy.
Left parasternal heave, gallop rhythm, a
systolic ejection click and pulmonary
element of the second heart sound is
accentuated. Central cyanosis may
develop at a later stage. The dyspnea
gradually increases and results in death
from right heart failure. If diagnosis is
made early and patient is given long
term anti-coagulant therapy a marked
reduction in pulmonary artery pressure
may occur with considerable
improvement.
Diagnostic aids - The diagnosis is
usually made on clinical evidence
particularly in the early stages of the
disease, because ancillary aids such as;
direct radiography which usually gives
negative findings until consolidation of
the lung or a pleural effusion had
developed a few days later is not very
helpful. Electrocardiography in general
reveals no abnormality unless at least
one half of a lung is out of action. Serum
albumin tagged with radioactive isotopes
can be injected intravenously and the
lung fields scanned. This method
unfortunately is unreliable and non
specific. Arteriography is useful but a
complicated test and should not be done
unless embolectomy is contemplated.
Since the first embolic incident is often
not fatal. Proper diagnosis in time can be
life saving. Whenever an embolism is
discovered there will be deep venous
thrombosis present some where in the
body. The possibility of a second
embolus which may be fatal in most
cases should be kept in mind. Women
who had one embolism will have a
second, in nearly one third of the cases if
left untreated, and one fifth of these will
die as a result. However, if treatment is