Pe

[tammer]

Hi Dr. Fett,

When I was diagnosed (sep/05) I also had PE and was on coumadin until last November when my EF was 34 at which time I was weaned off.
Well after a week of "rib pain" I spent 4 hours in Emerg. today and they are pretty sure I have yet another clot (elevated d-dimer). I am having a VQ scan tomorrow and have been restarted on another annoying regime of coumadin.
I am pretty sure the VQ will be positive for PE, have you seen this type of situation before?
I'm sure they will eventually need to run the gamet of tests to rule out a clotting disorder of some sort but could it also be that my heart is still floppy and weak and throwing clots. My current EF by MUGA is 37 done a few weeks ago.
Thanks,
Tammy

[amyls]

I do have a clotting disorder, it's called antiphosphidlipid antibodies. I have been on coumadin for almost 7 yrs. I also had a stroke while on the CCU. I hope you find your answers and if you have any queastions, pls feel free to e-mail me.

I know when my EF finally reached 35-40% my cardio said, from the cardiac side it could be stopped, but with the stroke and with APS, I will remain on it for life.


amy
amyskrobis@yahoo.com

[JAMESFETT]

Hi tammy. I'm sorry for the additional difficulties. If you have had another pulmonary embolism, I think it is not so much due to the EF (which for your left ventricle is relatively recovered beyond the usual zone for sludging and development of clot in the ventricle) but possibly some other underlying reason for increased risk of forming clot. Do you have any difficulty with leg veins, and thrombophlebitis? Most often, a pulmonary embolus will come from the right side of the heart, the right ventricle, and I wonder about the status of your RV function? Fortunately the coumadin regimen will prevent recurrence. Best wishes,

JD

[JAMESFETT]

Amy's suggestion about antiphospholipid antibodies contributing to formation of blood clot is a good idea. These antibodies have been associated with recurrent pulmonary emboli and other clot formation. I continue to be very interested in the association of these antibodies with some forms of viral infection, including parvovirus B-19, which can also be associated with myocarditis and cardiomyopathy (see article below).

JD

Autoimmun Rev. 2007 Apr;6(5):278-85. Epub 2006 Oct 13. Links
Human parvovirus B19 infection and antiphospholipid antibodies.von Landenberg P, Lehmann HW, Modrow S.
Institut fur Klinische Chemie und Laboratoriumsmedizin, Johannes Gutenberg Universitat Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.

Erythema infectiosum is the main manifestation of human parvovirus B19 infections. Further B19-related diseases commonly associated with the acute infection are flue-like symptoms, transient aplastic crisis, transient arthralgias, leukopenia and thrombocytopenia, spontaneous abortion and hydrops fetalis in pregnant women. Hepatitis, myocarditis, meningitis, encephalitis as well as pure red cell anemia may occur occasionally. In addition parvovirus B19 infections have been frequently described as cause or trigger of various forms of autoimmune diseases affecting all blood cell lines, joints, connective tissue, uvea, large and small vessels. Molecular mimicry may be one major contribution to the appearance of autoimmune antibodies, f.e. antiphospholipid and antineutrophil cytoplasmic antibodies as well as antinuclear antigens. These mechanisms implicated in the pathogenesis of parvovirus B19 triggered autoimmune diseases, especially focused on the development of antiphospholipid antibodies will be discussed in this short review.

[tammer]

Thanks for your responses. If I remember correctly though, wouldn't I have to be tested for clotting disorders when off coumadin for a period of time? Now I think that ship has sailed.
Tammy

[JAMESFETT]

Yes, many of the abnormal clotting investigations have to be done while off coumadin, such as for presence of Proteins A & C; however, I am not certain about the testing for antiphospholipid antibodies, so best to review that with your physicians and labs.

JD