• Pulmonary embolism

    by  • 06/06/2013 • Respiratory

    Pulmonary embolism

    Definition

    1. A blockage of the pulmonary artery, often caused by thrombo-embolism of a DVT.
    2. Causes obstructed bloodflow through lungs and causes back up of blood. This puts pressure on the R-heart and this produces the symptoms of PE (RHF picture) – eventually leading to cor pulmonale over time.

     

    Incidence

    1. 15% of all DVTs become PEs

     

    Epidemiology

    ?

    Presenting complaint

    1. Dyspnoea and course crackles
    2. Chest pain on inspiration
    3. Heart palpitations
    4. Cyanosis
    5. Pleural rub
    6. Haemoptysis
    7. Tachypnoea / tachycardia
    8. L-parasternal heave
    9. Low grade fever
    10. Raised JVP
    11. Hypovolaemia
    12. Sudden death

     

    Diagnostic tools/investigations

    1. Clinical suspicion findings
    2. CT pulmonary angiography (CTPA)
    3. Elevated D-dimer (not overly reliable – reports fibrin degradation – not specific)
    4. CXR / USS
    5. ECG – may show a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III (“S1Q3T3) as well as a sinus tachycardia

     

    Aetiology

    1. Cancer (prothrombotic state)
    2. Extended bed rest (post-op) / immobilised legs (plaster cast)
    3.  
    1. Long haul flights (economy syndrome)
    2. Genetic thrombophilia (FH of VTE)
    3. Acquired thrombophilia
    4. HRT / OCP and oestrogen containing meds
    5. AF
    6. Mechanical valve/stents/joint replacments

     

    Pathophysiology

    1. Blockage of main pulmonary artery leading to a poor pulmonary blood supply = VPI

     

    Hereditary? Infective? How does it spread?

    Treatment and management (conservative/medical/surgical)

    1. Treatment is typically with anticoagulant medication, including heparin and warfarin. Severe cases may require thrombolysis with drugs (…plase) such as tissue plasminogen activator (tPA) / streptokinase, or may require surgical intervention via pulmonary thrombectomy / embolectomy.

     

    Prognosis

    Untreated PE mortality is 26% 

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