Submassive Pulmonary Embolism
Acute Retroviral Syndrome
- a nefarious and cryptic disease
- definition in our shop:
- lobar or greater clot burden
- normotension
- Right ventricular dilatation/dysfunction by CT, cardiac biomarker, or echocardiogram
- In normotensive patients who are found to have RVD:
- Risk of shock is 10%
- Risk of death is 5%
- In patients who receive TPA for PE:
- Risk of major hemorrhage is 24%
- Risk of hemorrhagic stroke is 3-5%
- So who gets consideration for lytics (again, in our shop)?
- Submassive PE with:
- Elevated shock index
- Episodic hypotension
- SaO2 <92% with distress
- All Massive PE (Lobar or proximal clot with sustained hypotension or bradycardia)
- Submassive PE with:
Acute Retroviral Syndrome
- Phase during acute infection when HIV RNA and p24 are detectable but Ab is not
- Viral loads can reach >10,000,000 copies
- High rates of transmission to intimate partners
- 80-98% are symptomatic
- onset is 1-4 weeks following exposure
- Symptoms include:
- Fever
- Myalgias
- Skin rash
- Headache
- When to test?
- Suspicion for another STD
- Opportunistic infection
- High risk sexual behavior
- Signs of acute retroviral syndrome
- Early identification benefits during acute infection include:
- Reduction of transmission to partners
- Reduction of viral diversity, which reduces resistance
- Reduction of lymphatic latent infection/inflammation
- Prevention of delay in diagnosis