Pulmonary embolism is the sudden partial or total obstruction of the trunk of the pulmonary artery and or its branches by a foreign body usually fibrino-cruoric. It remains a major challenge in medicine despite advances in prevention, diagnosis and treatment. Between 70 and 80% of pulmonary embolisms are thought to be the complication of venous thrombosis of the lower limbs^[1]. In France, data from a Breton registry report an incidence of pulmonary embolism of 6 per 10,000 patients per year^[2]. In Mali the hospital prevalence is 5.28%^[3].

The objectives of this work were to determine the hospital prevalence of pulmonary embolism in the young person and to identify epidemiological, clinical and their evolutions in the cardiology department of the Point G Hospital.

Materials and Methods

This was a prospective and analytical study carried out in the cardiology department of the Point G Hospital from 01 January 2018 to 31 December 2018 and concerned all patients admitted during the study period

The inclusion criteria were young patients aged 15 to 40 years, both sexes hospitalized in the so-called pulmonary embolism ward confirmed by angioscanner during the study period.

Included in the study were:

•Young patients hospitalized on suspicion of pulmonary embolism but not performing pulmonary angioscanner

•Confirmed pulmonary embolism in patients over 40 years of age.

Data collection

Patients were recruited from the hospitalization file. The parameters studied in this file were sociodemographic data, clinical discovery circumstances, NFS results, D-dimers, fasting blood sugar, creatininemia, blood ionogram and pulmonary angioscanner. Word and Excel 2013 software was used for data entry and SPSS 16.0 and Epi Info 3.3.2 software for analysis. The static test used was the ki2 with a 5% meaning threshold.

Results

During the study period, out of 1379 patients admitted,19 patients were admitted for pulmonary embolism of the young subject, representing a hospital prevalence of 1.37%. The predominance was female with a sex ratio of 0.11% in favour of women. The age group most affected was 21-30 years or 47.4%. The reasons for consultation were chest pain and dyspnea in 94.7% and 89.5% of cases respectively. Factors predisposing to pulmonary embolism were dominated by peri partum, cardiomyopathy and obesity with 47.3%, 31.57% and 21.1% respectively. The reasons for consultation were chest pain and dyspnea in 94.7% and 89.5% respectively. Oxygen desaturation of less than 90% was observed in 41.1% of patients. Blood pressure was normal in the majority of cases (94, 8%). Thrombophlebite was observed in 36.8% and signs of right ventricular insufficiency in 26.3% of patients. Pulmonary embolism was unlikely in the majority, 60.52% according to the Geneva and Wells score simplified. D-dimers in all patients were positive (100%), high troponine in 5.26% of cases. At the electrocardiogram, the rhythm was most often sinusal (94.7%) and tachycardia in 84.2%; right atrial hypertrophy (47.4%) S1Q3 in 42.1% cases. At the thoracic angioscanner the embolism was bilateral in 52.6% of cases and distal in 36.8% of patients. In 10 patients who performed cardiac ultrasound, pulmonary arterial hypertension (70%), dilation of the right ventricle (20%), dilation of the left ventricle (40%), segmental akinesia (20%) and a FEVG lowered in 30% of its cases. %. Hyper leucocytosis (47.4%), anaemia and low TP (22.2%) were the most found biological abnormalities. More than 2/3 (68.5%) our patients had an intermediate mortality risk according to the PESI score. The evolution was favorable without complication in 78.9% of patients. The average hospital stay was 10 days. Hospital mortality was 10.5%.

Table 1: Breakdown of Patients by Age and Sex

Table 2: Patient Breakdown by Factors Predisposing to PE

Table 3: Breakdown of patients by thoracic angioscanner outcome

Discussion

During the study period we collected 19 patients who met the criteria for inclusion in a population of 1,379 patients, representing a hospital frequency of 1.37%. This denotes the high index of pulmonary embolism in young people in our country, lower than the 5.28% of KoumaréY.R^[3]. which dealt with pulmonary embolism at any age?

The age group most affected was 21-30 years, the same was true in WALBANE^[4]. As far as sex is concerned, it was predominantly female (89.47%) which is classic in the literature^[5] and is explained by the thromboembolic over-risk observed in women related to the presence of a few factors specific to them: pregnancy, childbirth, contraception. Factors predisposing to pulmonary embolism were dominated by peri partum and heart disease with 47.30% and 31.57% respectively comparable to that of KANE^[6] which found 30.58% of heart disease. The reasons for consultations were chest pain and dyspnea in 94.7% and 89.5% of cases; this result is similar to that of KOUMARE YR^[3] in its study. Oxygen desaturation was observed in 41.1% and signs of right ventricular insufficiency in 26.3% witnessed the severity of pulmonary embolism in these patients. Thrombophlebitis was observed in 36.8%, higher than KANE^[6] which was 30.4%. According to the score of Geneva and Wells simplified pulmonary embolism was unlikely in the majority: 60.52% against 40% in the literature^[7]. At the electrocardiogram the rhythm was most often sinusal (94.7%) and tachycardia in 84.2%; right atrial hypertrophy (47.4%) and an S1Q3 aspect (42.1%) ECG is classic in pulmonary embolism. In 10 patients who performed cardiac doppler ultrasound, pulmonary arterial hypertension (70%), dilation of the right ventricle (20%) above all witness to the severity of pulmonary embolism; dilation of the left ventricle (40%), segmental akinesia (20%) and a lowered FEVG in 30% of the same cases in KANE^[6] and synonymous with an underlying heart disease. At the thoracic angioscanner the embolism was bilateral in 52.6% of cases and distal in 36.8% of patients; WALBANE^[4] it was bilateral in 61.90%. Hyper leucocytosis (47.4%), anaemia and low TP (22.2%) were the most found biological abnormalities; insufficient technical plateau and lack of financial means were factors limiting biological exploration including: SAPL, protein C and S, thrombophilia

The therapeutic arsenal remained conventional and due to lack of local availability and financial means, fibrinolytics were excluded. More than 2/3 (68.5%) our patients had an intermediate mortality risk according to the PESI score. Finally, the evolution was favorable without complication in 78.9% of patients with two deaths or a mortality of 10.52% against 5% of the literature. The average hospital stay was 10 days compared to 12 days at KANE^[6].

Conclusion

Pulmonary embolism (PE) is a common, serious multifactorial condition whose incidence increases with age. The female sexes are often the most affected. Clinical signs are not specific and based on the assessment of clinical probability. Pulmonary angioscanner remains the confirmation diagnosis. Its treatment is based on heparin and AVK-based anticoagulants in our context.

References

1. 1. CAILLARD, D., CLEREL, M. Travel and risk of venous thrombosis. (2001) Lancet févr 357(9255):554-555.

   Pubmed| Crossref| Others

2. 2. CHOPARD, R. Cardiologie pratique. Paris. (2017)

   Pubmed| Crossref| Others

3. 3. Koumaré, Y.R Embolie pulmonaire : Aspects épidémiologiques, cliniques, évolutifs et étiologiques dans le service de cardiologie de l’hôpital du Point G à propos de 40 cas. (2017) Thèse de médecine. Faculté de médecine de Kankou Moussa de Bamako 5-70.

   Pubmed| Crossref| Others

4. 4. WALBANE, M. Thèse de doctorat, MTEV CHU Gabriel Touré, Faculté de Médecine et d’odontostomatologie de Bamako. (2015) 45: 40-60.

   Pubmed| Crossref| Others

5. Barrelier, M.T., Lezin, B., Landy, S. Prévalence de la thrombose veineuse diagnostiquée par échographie doppler des membres inférieurs dans la suspicion d’embolie pulmonaire et de l’embolie pulmonaire confirmée. (2001) Masson 26 : 23-30.

   Pubmed| Crossref| Others

6. 5. KANE, K. Maladie thromboembolique veineuse dans le service de cardiologie du CHU Point G. (2016) Thèse de médecine. Faculté de Médecine, de Pharmacie et d’odontostomatologie de Bamako : 50.

   Pubmed| Crossref| Others

7. 6. Armand –Perroux, A., Barrelier, M-T. La thrombose veineuse : quoi de neuf ? (2008) Réanimation 17:736-744.

   Pubmed| Crossref| Others