Modern treatment of XXXX .

@entity1 @entity712 @entity932 @entity714 @entity5 @entity299 @entity1151 @entity2554 @entity1030 @entity453 @entity67 @entity551
Modern treatment of @entity1151 requires rapid and accurate diagnosis followed by risk stratification to devise an optimal management strategy. @entity1 at low risk have good outcomes simply with intensive anticoagulation treatment. Higher-risk @entity1 may require more aggressive intervention with thrombolysis or embolectomy. Clinical risk factors for an adverse outcome include increasing age, @entity5 , @entity712 , systemic arterial @entity551 , @entity1030 and @entity67 . A promising approach is the Geneva Prognostic Score, which is based upon a rapid clinical assessment. On physical examination, signs of @entity67 , including distended jugular veins and a right-sided S3 gallop, should be looked for. The electrocardiogram may show evidence of right ventricular strain with a new @entity714 or T wave inversion in leads V1-V4. The troponin level may be elevated as a marker of @entity299 and right ventricular microinfarction, even in the absence of @entity453 . The most useful imaging marker of high risk is the presence of moderate or severe right @entity2554 and hypokinesis on the echocardiogram, especially with progressively worsening right ventricular function despite intensive anticoagulation treatment. @entity1 at high risk should be considered for thrombolytic therapy or embolectomy rather than management with anticoagulation therapy alone. Special care must be taken to avoid thrombolytic therapy among @entity1 who might be susceptible to @entity932 . @entity932 reached a surprisingly high rate of 3.0% in the International Cooperative Pulmonary Embolism Registry of 2,454 prospectively evaluated @entity1151 @entity1 at 52 hospitals in seven countries. An alternative approach to @entity1 at high risk is a catheter-based or open surgical embolectomy. It is crucial to refer these @entity1 as quickly as possible, rather than delaying intervention until cardiogenic shock has ensued. Fortunately the current tools for risk stratification provide an "early window" for prognostication and can help the coordination of a definitive treatment plan with optimal results.
