Fabian AriasPhysician – Primary Care, Ecuador
Title: Pulmonary Embolism – Use of PESI Score
Pulmonary thromboembolism (PE) is usually due to deep vein thrombosis (DVT), these together represent the two conditions known as Venous Thromboembolism (VTE), it occurs due to predisposing elements that include endothelial damage, venous stasis and hypercoagulable states, collectively known as Virchow’s Triad. It is more common in men and the incidence increases with age. PE has a wide variety of presenting features, ranging from no symptoms to shock or sudden death. The most common presenting symptom is dyspnea followed by chest pain and cough. PE is stratified into massive, submassive, and low-risk based upon the presence or absence of hypotension and right ventricular dysfunction or dilation. This stratification is associated with mortality risk. When PE is suspected, an approach is suggested that combines the evaluation of pre-test clinical probability accompanied by the D-Dimer test and imaging by computed tomography pulmonary angiography. Management focuses on patient stabilization and anticoagulation, depending on the risk of bleeding. PE, left untreated, has a mortality of up to 30 percent, which is significantly reduced with anticoagulation. The highest risk occurs within the first seven days, with death most commonly due to shock. Prognostic models that incorporate clinical findings (eg, Pulmonary Embolism Severity Index [PESI] and the simplified PESI [sPESI]) and/or biochemical markers that indicate right ventricle strain (natriuretic peptides, troponin) can predict early death and/or recurrence.
Fabián Arias, a doctor graduated from the Central University of Ecuador in the year 2020, throughout my short career I have participated in several international medical congresses, as well as a speaker at a national congress in Ecuador, I was able to meet my duty and my humanistic and altruistic work as a doctor doing my year of rural health in the province of Manabí where I obtained recognition from the local authorities as Director of the Health Center in 2021. I was President of the Organization of Rural Health Professionals at the National level during the period 2020. I have written several articles published in international journals in Spain, Mexico and Latin America, in turn I currently graduated from the Master of Public Health with a Mention in Epidemiology at the Andrés Bello University of Chile and completing the Master's Degree in Occupational Safety and Health at the University of the Americas in Ecuador, I am preparing to start my specialty in Cardiovascular Surgery in Argentina.